Patients still face an increased risk of debilitating rebound illness within 6 months of drug termination without an effective but measured strategy for de-escalating therapy from cell-trafficking medicines (fingolimod and natalizumab). As a well-established, safe, and effective treatment for relapsing MS, teriflunomide rapid load (TRL) regimen is an attractive and promising option to help in this situation. TRL has been shown to be safe and well-tolerated in healthy controls and extrapolating from similar loading regimens with its parent compound leflunomide, in patients with other autoimmune diseases (rheumatoid arthritis ). Since this method may achieve levels similar to steady-state serum concentration in days rather than months with the standard daily regimen, researchers decided to implement it and evaluate its safety and effectiveness in avoiding disease relapse. Here, they looked at 40 inactive individuals who had been stable while using cell-trafficking drugs but had to stop therapy for different reasons (illness, pregnancy desire, danger of Progressive multifocal leukoencephalopathy) (no relapses nor new lesions in the previous 2 years). Between June 2018 and December 2021, they were given Teriflunomide rapid load. When the lymphocyte count reached 0.8 x 109 per liter, TRL was started. TRL included 70 mg daily for 5 days, then 14mg daily as maintenance. A patient’s vitals, serum liver enzymes, and cell counts were all meticulously tracked. In the current sample, the mean EDSS (Expanded Disability Status Scale) was 8.5, and only 4/39 patients (10.3%) had clinical rebound; nevertheless, none of them needed hospital hospitalization. With a mean EDSS of 5.4 and a median EDSS of 6.5, the historical cohort is significantly different from the TRL cohort, which has a mean EDSS of 4.25 and a median EDSS of 4.0. There had been no reports of any stomach distress. Hematological effects were comparable to those seen in clinical trials (9% neutropenia vs. 16%), and only 1/39 individuals saw an elevation in liver enzymes (x 3 ULN). The topic of hair thinning was not investigated. Reducing the likelihood of rebound illness after stopping cell trafficking agents is an important treatment goal. TRL is an encouraging method and risk reduction tool for doing so without compromising tolerability or safety.
Reference: ECTRIMS 2022
