Prescrire international
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Prescrire international · Mar 2015
Teriflunomide (AUBAGIO). Multiple sclerosis: just a metabolite of leflunomide.
In mid-2014, subcutaneous or intramuscular interferon beta injection is the standard disease-modifying treatment for patients with relapsing-remitting multiple sclerosis, in the absence of a better alternative. Teriflunomide, the main active metabolite of leflunomide, has been approved as an oral treatment in this setting. Both substances have immunosuppressive effects. ⋯ Fetal toxicity via semen cannot be ruled out. In practice, the adverse effects of teriflunomide in multiple sclerosis are disproportionate to its efficacy. It is better to choose interferon beta, despite its limitations.
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To help healthcare professionals and patients choose high-quality treatments that minimise the risk of adverse effects, we have updated our list of drugs to avoid in early 2015. This 2015 review of medications examined in these pages over a five-year period, from 2010 to 2014, identified 71 drugs that are more harmful than beneficial in all their authorised indications.
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According to trials conducted in hundreds of patients with sciatica, epidural corticosteroid injections have no demonstrated efficacy beyond the placebo effect, either in the short-term or the long-term. However, they expose patients to a risk of sometimes serious neurological adverse effects.