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Cladribine tablets, a highly effective (DMT), have been available in UK since 2017 for patients with highly active or RRMS.We reviewed 43 patients treated with Cladribine from 2018 to 2023, with a median age of 47.2 years, consisting of 34 females and 9 males.Results suggest that the administration of a single dose or delays in the second cycle due to lockdowns led to incomplete clinical responses and/or ongoing MRI activity. Adverse events included fatal bacterial endocarditis and de novo lung cancer diagnosis.Patients switching from high-efficacy (DMTs) often experienced higher MRI disease activity, while those transitioning from low-efficacy DMTs or treatment-naive patients showed positive outcomes.99% of patients experienced moderate lymphopenia, averaging an 18-month resolution time. Eosinophilia was noted in 20% post-second-cycle of treatment and correlated with improvements in the (EDSS).Transient liver function changes occurred in 30%, 10% experienced thyroid alterations. Alopecia and skin rashes were rare, and recurrent UTI and URTI infections responded well to antibiotics.Considering these findings, we recommend that treatment schedules should not be disrupted by seasonal viral illnesses. Timely delivery of the second cycle is vital for efficacy, and prompt treatment of bacterial infections is essential, along with ongoing cancer surveillance for older multiple sclerosis patients on DMT.abureeta@gmail.com