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Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report

RATIONALE: Teriflunomide is an inhibitor of pyrimidine synthesis available as a first-line treatment for relapsing-remitting multiple sclerosis. Drug-induced liver damage is a relevant problem in clinical practice, representing a frequent cause of treatment discontinuation. This case report describe...

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Autores principales: Ferreira, Cristiane Munaretto, de Vasconcelos-Pereira, Erica Freire, de Oliveira, Vanessa Marcon, Salgado, Pedro Rippel, Domingos, João Américo, Monreal, Maria Tereza Ferreira Duenhas, Guerra-Shinohara, Elvira Maria, Gubert, Vanessa Terezinha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701948/
https://www.ncbi.nlm.nih.gov/pubmed/34941096
http://dx.doi.org/10.1097/MD.0000000000028246
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author Ferreira, Cristiane Munaretto
de Vasconcelos-Pereira, Erica Freire
de Oliveira, Vanessa Marcon
Salgado, Pedro Rippel
Domingos, João Américo
Monreal, Maria Tereza Ferreira Duenhas
Guerra-Shinohara, Elvira Maria
Gubert, Vanessa Terezinha
author_facet Ferreira, Cristiane Munaretto
de Vasconcelos-Pereira, Erica Freire
de Oliveira, Vanessa Marcon
Salgado, Pedro Rippel
Domingos, João Américo
Monreal, Maria Tereza Ferreira Duenhas
Guerra-Shinohara, Elvira Maria
Gubert, Vanessa Terezinha
author_sort Ferreira, Cristiane Munaretto
collection PubMed
description RATIONALE: Teriflunomide is an inhibitor of pyrimidine synthesis available as a first-line treatment for relapsing-remitting multiple sclerosis. Drug-induced liver damage is a relevant problem in clinical practice, representing a frequent cause of treatment discontinuation. This case report describes the occurrence of liver injury, with a 33.7-fold increase in the upper limit of normality of the liver enzyme alanine aminotransferase during treatment with teriflunomide 14 mg. PATIENT CONCERN: A 44-year-old woman receiving teriflunomide 14 mg for the treatment of multiple sclerosis presented symptoms suggestive of liver dysfunction 54 days after starting treatment. The patient had no history of using disease-modifying therapy, neither previous liver disease nor other comorbidities. DIAGNOSTICS: The suggested diagnosis was drug-induced liver injury, classified as hepatocellular. Other possible hepatic and autoimmune etiologies were ruled out. INTERVENTIONS: Replacement of teriflunomide treatment with glatiramer acetate and follow-up of the disease. OUTCOMES: Signs and symptoms regressed after treatment with teriflunomide 14 mg was discontinued, with normalization of liver enzyme activity in ∼5 months. The causality assessment of the adverse drug reaction was determined by the Naranjo scaling system, resulting in probable, with a final score of 7. CONCLUSIONS: Teriflunomide-induced liver injury in patients with multiple sclerosis is a serious adverse reaction. The report of this case contributes to updating knowledge about the safety aspects of treatment with teriflunomide and planning of monitoring strategies and patient risk management.
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spelling pubmed-87019482021-12-27 Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report Ferreira, Cristiane Munaretto de Vasconcelos-Pereira, Erica Freire de Oliveira, Vanessa Marcon Salgado, Pedro Rippel Domingos, João Américo Monreal, Maria Tereza Ferreira Duenhas Guerra-Shinohara, Elvira Maria Gubert, Vanessa Terezinha Medicine (Baltimore) 4200 RATIONALE: Teriflunomide is an inhibitor of pyrimidine synthesis available as a first-line treatment for relapsing-remitting multiple sclerosis. Drug-induced liver damage is a relevant problem in clinical practice, representing a frequent cause of treatment discontinuation. This case report describes the occurrence of liver injury, with a 33.7-fold increase in the upper limit of normality of the liver enzyme alanine aminotransferase during treatment with teriflunomide 14 mg. PATIENT CONCERN: A 44-year-old woman receiving teriflunomide 14 mg for the treatment of multiple sclerosis presented symptoms suggestive of liver dysfunction 54 days after starting treatment. The patient had no history of using disease-modifying therapy, neither previous liver disease nor other comorbidities. DIAGNOSTICS: The suggested diagnosis was drug-induced liver injury, classified as hepatocellular. Other possible hepatic and autoimmune etiologies were ruled out. INTERVENTIONS: Replacement of teriflunomide treatment with glatiramer acetate and follow-up of the disease. OUTCOMES: Signs and symptoms regressed after treatment with teriflunomide 14 mg was discontinued, with normalization of liver enzyme activity in ∼5 months. The causality assessment of the adverse drug reaction was determined by the Naranjo scaling system, resulting in probable, with a final score of 7. CONCLUSIONS: Teriflunomide-induced liver injury in patients with multiple sclerosis is a serious adverse reaction. The report of this case contributes to updating knowledge about the safety aspects of treatment with teriflunomide and planning of monitoring strategies and patient risk management. Lippincott Williams & Wilkins 2021-12-23 /pmc/articles/PMC8701948/ /pubmed/34941096 http://dx.doi.org/10.1097/MD.0000000000028246 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/)
spellingShingle 4200
Ferreira, Cristiane Munaretto
de Vasconcelos-Pereira, Erica Freire
de Oliveira, Vanessa Marcon
Salgado, Pedro Rippel
Domingos, João Américo
Monreal, Maria Tereza Ferreira Duenhas
Guerra-Shinohara, Elvira Maria
Gubert, Vanessa Terezinha
Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title_full Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title_fullStr Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title_full_unstemmed Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title_short Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: A case report
title_sort hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis: a case report
topic 4200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701948/
https://www.ncbi.nlm.nih.gov/pubmed/34941096
http://dx.doi.org/10.1097/MD.0000000000028246
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