Teriflunomide in Patients with MS and COVID-19

A case report and literature review examined the effect of teriflunomide in patients with multiple sclerosis (MS) who develop COVID-19.

The subject of the case report was a 57-year-old male with MS who was treated with teriflunomide and developed a mild case of COVID-19. The literature review consisted of the five papers published since February 2020 discussing 14 patients with MS who contracted COVID-19 while on teriflunomide treatment. The cohort had an average age of 50.5 ± 11.3 years, and 53% of patients were female. The median Expanded Disability Status Scale (EDSS) score was 2.25 (range, 0-6), and patients had been on teriflunomide treatment for an average 3.7 ± 1.6 years. Four patients had relevant comorbidities. All patients with COVID-19 had a fever; the other most common symptoms were gastrointestinal disturbances (67%), fatigue (55%), and cough (55%). Five patients went to the hospital, and two needed oxygen support.

When evaluating the entire study cohort and comparing the patients who required hospitalization (n=5) versus those who did not (n=10), the hospitalized group was significantly older (59.6 years vs. 45.9 years; P=0.025), but there were no significant differences in sex, EDSS, duration of teriflunomide therapy, and comorbidities. All patients had good outcomes. Recovery time varied from a few days to several weeks. All but two patients continued their teriflunomide treatment regimen during the course of their COVID-19 infection.

The man from the case report had a short duration of teriflunomide therapy by about 2.5 years compared with that of the literature review group and had a median EDSS score 1.5 points lower. He required hospitalization and had significant comorbidities but did not require oxygen support, did not need intensive care, and returned home after 10 days, so he was considered to have good outcomes. He remained on teriflunomide therapy during the course of his disease.

“Available data suggest that teriflunomide therapy should not be discontinued in [patients with] MS who develop SARS-CoV-2 infection, also in presence of significant comorbidities or clinical conditions requiring hospitalization,” the study authors concluded. “Additional studies are necessary to assess if the drug can also have a protective role against SARS-CoV-2.”