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MS – Teriflunomide Washout — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Teriflunomide WashoutSCE Neurology

A 32-year-old with relapsing-remitting multiple sclerosis takes teriflunomide and has a positive pregnancy test. She wants to minimise fetal exposure. What is the appropriate elimination strategy?

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Correct answer: B — Start accelerated elimination with cholestyramine or activated charcoal for 11 days and confirm the required plasma concentration

Teriflunomide can persist for a prolonged period because of enterohepatic recirculation. Where pregnancy is planned or suspected, the UK SmPC recommends an accelerated elimination procedure: cholestyramine (or activated charcoal) for 11 days followed by confirmation that the plasma concentration is below the specified threshold. This is not synonymous with every routine DMT switch.

Reference: Teriflunomide UK Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/100504/smpc