Teriflunomide "under the microscope" or what it's like to live with MS in the North
The Teri-LIFE study examined teriflunomide very comprehensively. How does it manage to affect the quality of life of patients with multiple sclerosis (MS) according to data from real clinical practice in the Nordic countries? What is adherence to this therapy like? And what are its health-economic consequences? We briefly summarize the answers to these questions.
Introduction
Teriflunomide is one of the modern oral disease-modifying drugs (DMDs) used in the therapy of MS. Its therapeutic effect in this indication is primarily based on reducing the number of lymphocytes. This immunomodulatory substance with anti-inflammatory effects selectively and reversibly inhibits the mitochondrial enzyme dihydroorotate dehydrogenase, which is functionally related to the respiratory chain. As a consequence of this inhibition, teriflunomide generally reduces the proliferation of rapidly dividing cells that depend on de novo pyrimidine synthesis necessary for growth.
The safety and efficacy of teriflunomide have already been more than sufficiently proven in clinical studies (TEMSO, TOWER, TOPIC). Leading experts from the Nordic countries, however, decided to look at the issue of teriflunomide in patients with multiple sclerosis very comprehensively and in the environment of real clinical practice. In addition to assessing efficacy and safety, they also focused on its impact on overall quality of life and health-economic aspects.
Study Methodology
Teri-LIFE was a prospective open observational multicenter study that included 200 patients treated with teriflunomide from 3 Nordic countries (Denmark, Sweden, Norway). The primary outcome was the results obtained based on the assessment of the quality of life questionnaire (Short Form 36). In addition to this questionnaire, which was filled out by patients at the beginning of the study and subsequently at 6-month intervals, clinical efficacy, fatigue, safety, treatment satisfaction (Treatment Satisfaction Questionnaire for Medication – version 1.4), adherence, and health-economic correlations were also evaluated during the same period.
Results
The results of the Teri-LIFE study showed stable values of scores in the quality of life questionnaire Short Form-36 over the 2-year observation period. No change was observed in the assessment of fatigue levels. Another good news is the significant reduction in the annual occurrence of relapses compared to the period before the initiation of therapy.
Regarding treatment satisfaction, the average scores of the individual domains of the Treatment Satisfaction Questionnaire for Medication increased between the 6th and 24th month. The highest average score was recorded in the domains dealing with comfort and side effects. This was also reflected in generally high adherence to treatment. Overall, the use of teriflunomide led to reduced healthcare utilization.
Conclusion
The Teri-LIFE study demonstrated numerous benefits of teriflunomide. In addition to already known efficacy and good safety profile, it also confirmed the anticipated positive impact on maintaining quality of life and high adherence to treatment, likely due in part to its user-friendly administration form.
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Source: Hestvik A. L. K., Frederiksen J. L., Nielsen H. H. et al. Real-world study of relapsing-remitting multiple sclerosis patients treated with teriflunomide in Nordic countries: quality-of-life, efficacy, safety and adherence outcomes. Mult Scler Relat Disord 2022 Jul; 63: 103892, doi: 10.1016/j.msard.2022.103892.
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