Oral Therapies Come of Age for Multiple Sclerosis

Multiple sclerosis is a chronic, inflammatory, autoimmune disease of the central nervous system that affects more than 2.1 million people worldwide.¹ It is among the most common causes of neurological disability in young adults and occurs more frequently in women than men.

Patients with multiple sclerosis often experience muscle weakness and difficulty with coordination and balance. The advent of oral therapy now gives patients more options besides injections, which were the mainstay treatment. Currently only three oral multiple sclerosis (MS) treatment options have been approved: Aubagio², Gilenya³, and Tecfidera⁴ .

Teriflunomide (Aubagio, Genzyme)

Approved 9/12/12

How it works:

Teriflunomide, an immunomodulatory agent with anti-inflammatory properties, inhibits dihydroorotate dehydrogenase, a mitochondrial enzyme involved in de novo pyrimidine synthesis. The mechanism by which teriflunomide exerts its therapeutic effect is unknown but may involve a reduction in the number of activated lymphocytes in the CNS.

Things to look out for:

• Hepatotoxicity
• Decreased WBC count
• Peripheral neuropathy
• Acute renal failure
• Hyperkalemia
• Increased blood pressure

Use in Special Populations:

• Pregnancy: Category X. Contraindicated in women who are pregnant or women of child bearing potential not using reliable contraception. There is a registry that monitors pregnancy outcomes in women exposed to Aubagio during pregnancy.  Encourage patients to enroll by calling (800) 745-4447. Men wishing to father a child should discontinue use and undergo an accelerated elimination procedure before doing so.
• Nursing mothers:  It is not known whether the drug is excreted in human milk. A decision should be made whether to discontinue the drug or discontinue nursing.
• Children: Safety and effectiveness in pediatric patients have not been established.
• Elderly: Clinical studies did not include patients 65 yrs old.
• Renal impairment: No dosage adjustment is necessary.
• Hepatic impairment: Contraindicated in patients with severe hepatic impairment; no dosage adjustment is needed for those with mild or moderate impairment.

What to tell your patients:

• Liver enzymes will be checked before starting therapy and for at least 6 months while taking Aubagio.
• Women of childbearing potential need effective contraception during treatment.
• An accelerated elimination procedure may be used if needed since Aubagio may stay in the blood for up to 2 years.
• WBC counts will be checked before starting therapy. Patients may be more likely to be at risk for infections. Live vaccines should be avoided during treatment and for at least 6 months after discontinuation.
• Contact physician if numbness or tingling of hands or feet develop.
• May increase blood pressure.

This article originally appeared on MPR