Teriflunomide: A Novel Oral Treatment for Relapsing Multiple Sclerosis

The document reviewed teriflunomide, an oral medication for relapsing multiple sclerosis (RMS), highlighting its mechanism as a DHODH inhibitor, which reduces the proliferation of T- and B-cells. Teriflunomide was found to be effective in reducing annual relapse rates and slowing disability progression, with a safety profile that supports its use as a first-line treatment for RMS. The TEMSO and TOWER Phase III clinical trials demonstrated its efficacy, with the TOWER study showing a 22.3% and 36.3% reduction in ARR for 7 mg and 14 mg doses, respectively. The TENERE study found no significant difference in effectiveness compared to IFN-B-1a, and the TOPIC study showed a reduced risk of CIS converting to MS. Side effects were generally mild, with hair thinning, diarrhea, and elevated liver enzymes being the most common. Teriflunomide is approved by the FDA and the European Medicines Agency and is recommended in Canada for patients who have not responded to other treatments. It is considered cost-effective and convenient, with further studies planned, including in pediatric populations.