New and Evolving Treatment Goals in Multiple Sclerosis – the Role of Teriflunomide

T eriflunomide is an oral immunotherapy agent that acts primarily as an inhibitor of dihydroorotate-dehydrogenase (DHODH), a key mitochondrial enzyme involved in the synthesis of pyrimidines in rapidly proliferating cells such as T lymphocytes and B lymphocytes, thus attenuating the inflammatory response to auto-antigens. The TEMSO and TOWER phase III clinical studies have demonstrated the efficacy and safety of teriflunomide in the first-line treatment of patients with relapsing multiple sclerosis (MS), with long-term follow-up data available up to 9 years. Teriflunomide has also been shown to decrease the risk of conversion to clinically definite MS (CDMS) in patients with a first clinical sign of MS or risk of conversion to CDMS after a clinically isolated syndrome. In addition to reducing disability progression and relapse rate, teriflunomide has also been found to decrease imaging activity and is associated with significant reductions in brain volume loss. The convenience of administration of teriflunomide should establish its role within the growing number of treatment options for MS.