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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
In the acute phase, inflammation may be suppressed by oral or intravenous methylprednisolone, which reduces the duration of relapse but not the extent of recovery. In patients with substantial disease activity, relapse frequency and, possibly, the accumulation of disability (at least in the short term) can be reduced by immunosuppressive drugs such as interferon beta, glatirimer acetate, teriflunomide, fingolomod or dimethylfumarate. In patients with highly active disease (relapses despite immunosuppressive treatment), natalizumab or alemtuzumab may be effective. However, powerful immunosuppression can be associated with development of a serious opportunistic viral brain infection, progressive multifocal leucoencephalopathy, so the benefits of treatment need to be balanced against the risks, and patients receiving such treatments should be under the continuing review of a specialist MS clinic.
Optical Coherence Tomography (Oct) and Fundus Fluorescein Angiography (FFA) in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Ramandeep Singh, Deeksha Katoch, Mohit Dogra, Basavaraj Tigari, Simar Rajan Singh, Sahil Jain, Bruttendu Moharana, Sabia Handa, Mangat R. Dogra
She was seen by neurologist and her MRI was done. She was diagnosed as a case of multiple sclerosis presenting with optic neuritis in the left eye. The patient was given intravenous methylprednisolone 1 g OD for 5 days followed by oral steroids (starting with 1 mg/kg) and then in tapering doses. She was initiated on disease modifying therapy with teriflunomide (14 mg per day).
Organ-specific autoimmune diseases
Published in Gabriel Virella, Medical Immunology, 2019
Gabriel Virella, George C. Tsokos
Recently, several new pharmacological agents have been found to be useful in the treatment of MS. Teriflunomide, a pyrimidine synthesis inhibitor, has been found in phase III trials to be equivalent to IFNβ. Dimethyl fumarate has a comparable clinical effect that correlates inversely with lymphocyte counts and has been approved by the U.S. Food and Drug Administration (FDA). Fingolimod, a sphingosine-1-phosphate-1 receptor antagonist, inhibits the egression of lymphocytes from lymph nodes to the bloodstream. It has been shown to have a good clinical effect and has also been approved by the FDA. Natalizumab is a humanized monoclonal antibody that recognizes the adhesion molecule α4 integrin and blocks its interaction with the vascular cell adhesion molecule 1. Natalizumab has great clinical efficacy. A downside is there is a substantial risk for the development of progressive multifocal leukoencephalopathy caused by activation of the JC virus. Other monoclonal antibodies shown to be clinically valuable and used to treat MS are the B cell–depleting antibodies (rituximab and ocrelizumab).
The ULTIMATE trials: are there advantages of ublituximab over teriflunomide in relapsing multiple sclerosis?
Published in Expert Opinion on Biological Therapy, 2022
One of the present standard treatments for relapsing multiple sclerosis is teriflunomide. It is the active metabolite of leflunomide, a disease-modifying antirheumatic drug (DMARD)/immunosuppressant used in rheumatoid arthritis. Teriflunomide inhibits dihydroorotate dehydrogenase, a key mitochondria enzyme in pyrimidine synthesis for DNA replication, to reduce T- and B-cell activation, proliferation, and function in response to autoantigens [2]. Teriflunomide reduces the number and size of lesions in subjects with relapsing multiple sclerosis, but also increased the levels of alanine aminotransferase (a marker of liver damage) [3]. Teriflunomide also causes hair loss, and its use is limited because it is teratogenic in both men and women with a two-year wash-out required in those wishing to become pregnant [2].
Psoriasiform eruption caused by teriflunomide in a patient with multiple sclerosis
Published in Clinical Toxicology, 2019
Senay Agirgol, Murat Kurtuncu, Mihriban Gurbuzel, Ilay Tasyurek, Tuncay Gunduz
Teriflunomide is a relatively new oral medication that is introduced as first-line treatment in patients with multiple sclerosis. Teriflunomide inhibits dihydroorotate dehydrogenase (DHODH), hence suppressing the proliferation of activated lymphocytes and limits the expansion of activated T and B cells, which start the inflammatory cascade in the central nervous system. It may cause many side effects related to skin including hair thinning and loss. However, teriflunomide induced psoriasiform eruption has never been reported before. Herein, we report a case with psoriasiform skin rash due to teriflunomide. Although rare, we believe that multiple sclerosis (MS) specialists should be aware of this rare side effect.
Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations
Published in Journal of Drug Assessment, 2020
Beatriz Canibaño, Dirk Deleu, Boulenouar Mesraoua, Gayane Melikyan, Faiza Ibrahim, Yolande Hanssens
Despite this, women of childbearing potential are still advised to use effective contraception while treated with teriflunomide and for 2 years after discontinuation of the drug unless accelerated elimination procedure has been used. Pregnancy planning while on teriflunomide requires a careful and timely strategy. Teriflunomide treatment should be discontinued if conception is desired or an unintended pregnancy arises, and an accelerated elimination procedure started followed by measuring of the serum level of the drug (target level <0.02 mcg/mL)122. Switching to an alternative DMD e.g. IFNβ, GA or natalizumab should be considered depending on the level of disease activity.