Objective: to evaluate the efficacy and safety of cladribine tablets as a treatment for immune reconstitution of highly active multiple sclerosis (HAMS) in general clinical practice.Patients and methods. 34 patients with HAMS who were followed up at the Moscow Multiple Sclerosis Center in 2018–2021 received two full treatment courses. HAMS diagnosis was established in the presence of two or more exacerbations per year without treatment or one exacerbation in patients receiving pathogenetic

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... ment in the presence of concomitant manifestations of the activity of the pathological process on MRI. Before initiation of cladribine therapy, the median exacerbation rate was 2.3 per year, i.e., 34 patients per year had a total of 78 exacerbations.Results and discussion. Only two clinical exacerbations were registered (one each in the first and second year) during two years of treatment among all 34 patients, the average frequency of exacerbations was 0.05 per year; in three cases, a subclinical exacerbation was noted - new Gd+ lesions on T2-weighted images on MRI, the total number of events was 0.15 per year. No significant adverse events were reported.Conclusion. Cladribine tablets are a highly effective and safe treatment option for HAMS.