Teriflunomide
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Crohn’s disease: case report A 49-year-old man developed Crohn’s disease during treatment with teriflunomide for relapsing-remitting multiple sclerosis. The man was diagnosed with relapsing-remitting multiple sclerosis in 2014. The onset of the disease was determined to be in 2003 when a possible diagnosis of central nervous system demyelinating disease was considered. After an initial treatment with glatiramer acetate, he started receiving dimethyl fumarate. But it was stopped due to side-effects of flushing and nausea. In January 2018 he started receiving oral teriflunomide 14 mg/day. After 6 months, he developed severe diarrhoea (10–12 bowel movements per day) and unintentional weight loss of 20 lbs within one month. His concomitant medication included ibuprofen. In September 2018, upper gastrointestinal endoscopy revealed non-bleeding gastric and duodenal ulcers. Colonoscopy revealed a single tubular adenoma in the rectum. The man was treated with omeprazole and the concomitant ibuprofen was stopped. A subsequent improvement in the symptoms was noted. However, in December 2018 a repeat upper gastrointestinal endoscopy revealed incomplete healing of duodenal ulcers. Teriflunomide dose was then decreased to 7 mg/day in the same month. He remained symptom free. However in August 2019 he experienced a recurrence of significant diarrhoea (15-20 times a day) and un-intentional weight loss of 30 lbs over three months. Based on the clinical presentation, a teriflunomide-induced colitis or Crohn’s disease was suspected. Teriflunomide was therefore discontinued. In October 2019 an upper gastrointestinal endoscopy revealed gastric, duodenal ulcers and esophagitis. On colonoscopy granularity, mild inflammation and some ulceration throughout the colon and ileum. Histopathological findings confirmed Crohn’s disease. In November 2019, he started receiving vedolizumab and achieved clinical remission after induction dosing. In March 2020 a follow up colonoscopy revealed ulcerations throughout the colon, but normal intervening mucosa in the left colon. Biopsy of the right colon revealed active inflammation. Azathioprine was added for better disease control, but he was eventually switched to ustekinumab monotherapy due to unspecified intolerance to vedolizumab. Later glatiramer acetate was restarted [not all outcomes stated]. Esfahani NZ, et al. Inflammatory colitis associated with Teriflunomide. Multiple Sclerosis and Related Disorders 46: Nov 2020. Available from: URL: http://doi.org/10.1016/ 803515825 j.msard.2020.102480
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Reactions 21 Nov 2020 No. 1831
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