CMSC 2012: Teriflunomide-associated Hair Thinning is Manageable

SAN DIEGO — In clinical trials, treatment of patients with the oral disease-modifying therapy (DMT), teriflunomide, for relapsing forms of multiple sclerosis (RMS) can result in hair loss/thinning, but this side effect is generally manageable, according to research presented at the Fourth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and America’s Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

Teriflunomide, the active metabolite of leflunomide, which has been used in the treatment of rheumatoid arthritis since 1998, inhibits dihydro-orotate dehydrogenase (DHODH), an enzyme that is key to the de novo synthesis of pyrimidine and has both antiproliferative and anti-inflammatory effects.

Given that MS is 2 to 3 times more common in women than men, hair loss and/or thinning associated with DMTs can be a significant concern, may be perceived as a potential barrier to treatment, and in some cases, may lead to premature treatment discontinuation.

Mark S. Freedman, MD, of the University of Ottawa in Ontario, Canada, and colleagues conducted a study to evaluate the incidence and severity of hair loss or thinning in 1,267 MS patients participating in clinical trials who received teriflunomide monotherapy, 7 or 14 mg/day, for as long as 10 years.

Compared with placebo-treated patients (4.3%), hair thinning or treatment-emergent adverse events associated with hair thinning were observed in 11.4% of teriflunomide 7-mg treated patients and 15.2% of 14-mg treated patients, suggesting a slight dose effect. Hair loss and/or thinning was generally mild to moderate in intensity and typically occurred early during treatment, peaking at approximately 6 to 9 months following treatment initiation. Overall, hair loss/thinning led to discontinuation of treatment in less than 3% of patients. Most patients did not need treatment for hair loss and recovered spontaneously.

“Hair thinning reported by patients in the teriflunomide clinical program was mild to moderate in intensity, rarely led to discontinuation of treatment, and in the majority of cases, patients recovered without corrective therapy,” the authors concluded.

This research was supported by Genzyme, a sanofi company.