Rebound after discontinuation of teriflunomide in patients with multiple sclerosis: 2 case reports

Fuerte-Hortigón, Alejandro; Ruiz, Rocío López; Hiraldo, Juan Diego Guerra; Fernández, Félix Sánchez; García‐Soto, Julio Dotor; Páramo, Maria Dolores; Ruiz-Peña, J. L.; Navarro-Mascarell, G; Eichau, Sara

doi:10.1016/j.msard.2020.102017

Cited by 7 publications

(3 citation statements)

References 4 publications

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“…In our case, the contrast-enhancing lesion has been seen after the 20th week of teriflunomide discontinuation because of the pregnancy. The time from drug withdrawal to the rebound syndrome was similar to the cases that have been reported in the literature [7]. However, there is a rapid restoration of cellular immunity following the cessation of the drug, the exact mechanism of RS in teriflunomide has not been known.…”

Section: Discussionsupporting

confidence: 79%

“…As new disease-modifying drugs (DMT) become available in the treatment of MS, medication discontinuation is often made for medication switches. In the washout periods, RS can be seen and disease reactivation usually occurs between 1-6 months following drug cessation [7,8]. In our case, the contrast-enhancing lesion has been seen after the 20th week of teriflunomide discontinuation because of the pregnancy.…”

Section: Discussionmentioning

confidence: 56%

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The rebound effect of teriflunomide: Case report

Acir¹

2022

J Clin Images Med Case Rep

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Teriflunomide is one of the first-line treatment in Multiple Sclerosis (MS). Cessation of medications can cause increased MS-related disease activity which has been characterized as rebound syndrome (RS). Rebound syndrome is not an expected syndrome when the drug is discontinued especially in first-line treatments. Teriflunomide therapy was discontinued in a twenty-five years old female patient due to pregnancy who was diagnosed with Relapsing-Remitting MS (RRMS). In the patient, clinical symptoms and radiological worsening were seen the 20th week after the cessation. We aimed to discuss through this case that immune system-modifying therapies can cause rebound syndrome, regardless of the mechanism.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 56%

The rebound effect of teriflunomide: Case report

Acir¹

2022

J Clin Images Med Case Rep

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“…Interruption of teriflunomide therapy can result in rebound disease for patients with relapsing-remitting MS, where it is one of the first-line oral medications. 44 Although it is generally accepted for teriflunomide to be continued perioperatively, it is unlikely that missing a few doses would affect disease activity given its long washout period (up to 2 years).…”

Section: Teriflunomidementioning

confidence: 99%

Preoperative Management of Medications for Neurologic Diseases

Oprea

Keshock

O’Glasser

et al. 2022

Mayo Clinic Proceedings

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Neurologic diseases are prevalent in patients undergoing invasive procedures; yet, no societal guidelines exist as to best practice in management of perioperative medications prescribed to treat these disorders. The Society for Perioperative Assessment and Quality Improvement tasked experts in internal medicine, anesthesiology, perioperative medicine, and neurology to provide evidence-based recommendations for preoperative management of these medications. The aim of this review is not only to provide consensus recommendations for preoperative management of patients on medications for neurologic disorders, but also to serve as an educational guide to perioperative clinicians. While, in general, medications for neurologic disorders should be continued preoperatively, an individualized approach may be needed in certain situations (eg, holding anticonvulsants on day of surgery if electroencephalographic mapping is planned during epilepsy surgery). Pertinent interactions with commonly used drugs in anesthesia practice, as well as considerations for targeted laboratory testing or perioperative drug substitutions, are addressed as well.

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