Pregnancy during therapy with teriflunomide. A clinical case of accelerated elimination of teriflunomide

Abstract

Despite warnings about the need to use effective contraception during therapy with teriflunomide, a number of patients still plan to become pregnant or inform their doctor that they are already pregnant while taking the drug. According to the drug's instructions, in these cases, therapy should be stopped right away and a procedure should be done to quickly get the teriflunomide down to a safe level in the blood plasma – no more than 0.02 μg/ml. The drug colestyramine, recommended for this purpose, is not registered in Russia. The proposed alternative use of activated charcoal at 50 g every 12 hours for 11 days (400 tablets per day) is fraught with undesirable side effects in the form of constipation, diarrhoea, and impaired absorption of calcium, vitamins and other nutrients, which is unacceptable for pregnant women and may have a negative effect on the fetus. The question arises: what to do in such cases? We have demonstrated a clinical case of accelerated elimination of teriflunomide in a pregnant patient using the drug Polysorb MP. The use of this tactic made it possible to reduce the concentration of the drug in the blood by 50 times within 1 month: from 1.39 to 0.028 μg/ml. As a result, a healthy full-term baby was born without congenital defects or developmental abnormalities.