Main Research Findings

Teriflunomide is an oral immunomodulatory drug approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). Teriflunomide has been shown to significantly reduce the relapse rate and sustained disability progression in RRMS in studies such as 2 , 1 , 15 , 10 , 13 . Additionally, 2 demonstrated that teriflunomide resulted in higher treatment satisfaction compared to interferon β-1a.

Reasons for Side Effects

Teriflunomide suppresses the immune response by inhibiting pyrimidine synthesis. This mechanism of action is explained in detail in 4 . As indicated in 9 and 11 , teriflunomide can affect the liver. 4 also shows that teriflunomide can activate the aryl hydrocarbon receptor (AHR), which promotes its own metabolism.

Common Side Effects

Gastrointestinal

As demonstrated in 8 and 5 , teriflunomide can cause gastrointestinal side effects. Specifically, diarrhea, abdominal pain, nausea, and vomiting have been reported. 4 suggests that teriflunomide can also cause peptic ulcers and bleeding.

Liver

Teriflunomide can impact the liver, as shown in 8 , 9 , and 11 . Increased liver enzymes and hepatitis have been reported. Additionally, 8 indicates that teriflunomide could lead to liver failure.

Blood

4 suggests that teriflunomide can cause thrombocytopenia and leukopenia.

Skin

12 indicates that teriflunomide could cause lichenoid drug eruptions.

Eye

7 suggests that teriflunomide may cause macular edema.

Side Effect Management

Gastrointestinal

If gastrointestinal side effects occur, diet and medication should be adjusted under the guidance of a physician depending on the severity of the symptoms.

Liver

If liver side effects occur, teriflunomide should be discontinued and appropriate treatment should be sought under the guidance of a physician.

Blood

If blood side effects occur, teriflunomide should be discontinued and appropriate treatment should be sought under the guidance of a physician.

Skin

If skin side effects occur, teriflunomide should be discontinued and appropriate treatment should be sought under the guidance of a physician.

Eye

If eye side effects occur, teriflunomide should be discontinued and appropriate treatment should be sought under the guidance of a physician.

Comparison Across Studies

Similarities

Many studies have shown that teriflunomide is effective in treating RRMS.

Differences

There is variability in the incidence and severity of side effects reported in teriflunomide studies. This could be due to differences in study design and patient populations.

Considerations for Real-World Application

Numerous studies have demonstrated the effectiveness of teriflunomide in treating RRMS. However, teriflunomide can affect the liver and blood. Therefore, regular checkups are essential when taking teriflunomide, following the physician's instructions.

Limitations of Current Research

The long-term safety of teriflunomide is not yet fully understood. Additionally, the mechanisms underlying teriflunomide's side effects have not been completely elucidated.

Future Research Directions

Further research is necessary to investigate the long-term safety of teriflunomide and to clarify the mechanisms underlying its side effects.

Conclusion

Teriflunomide has been proven effective and safe as a treatment for RRMS. However, it can impact the liver and blood. When taking teriflunomide, it is crucial to follow the physician's instructions and undergo regular checkups.