Teriflunomide treatment for relapsing-remitting multiple sclerosis: An experience from Saudi Arabia

Multiple sclerosis (MS) is a disease of the central nervous system in which the immune system attacks the myelin sheath that covers nerve fibers. It is an immune-mediated chronic inflammatory disease. Teriflunomide is a once-daily oral disease modifying therapy that was approved by the FDA for relapsing-remitting MS. This study aims to assess the effectiveness and tolerability of teriflunomide in MS patients in Saudi Arabia. A multicenter retrospective study conducted in 2 tertiary medical centers with specialized MS clinics in Saudi Arabia. All patients who used teriflunomide from March 2016 to September 2020 were included. A total of 38 people with MS (pwMS) were included which were predominantly female (60.5%) with a mean age of 37.1 years. In our study, 23.7% of pwMS on teriflunomide experienced at least 1 clinical relapse. Following the initiation of teriflunomide, 26.3% of the patients developed at least 1 new lesion on magnetic resonance imaging of the brain. No evidence of disease activity 3 was achieved in 63.2% of pwMS. Teriflunomide was discontinued in 14 (36.8%) patients. The most common reason for discontinuation was adverse effects (AEs) as reported by 8 (57.1%) patients. Overall, 18 (47.4%) of patients have experienced treatment AEs. The most reported type of AEs was hair thinning or loss which was reported by 15.8% of patients. Teriflunomide was modestly effective in controlling disease activity in pwMS in Saudi Arabia with the majority achieving no evidence of disease activity 3, although the mean expanded disability status scale increased slightly. However, the discontinuation rate was high most commonly due to AEs. Overall, the safety profile was consistent with real-world experience. Larger local studies are needed to confirm this finding.