Background Teriflunomide and dimethylfumarate are two new oral therapies for relapsing-remitting multiple sclerosis (RRMS). Due to the increase in patients with these treatments, face-to-face interviews were carried out with these patients in the outpatient area in order to obtain more information.
Purpose To analyse the reason for switching, safety and adherence to treatment in RRMS with dimethylfumarate (DMF) and teriflunomide (TRF).
Material and methods A retrospective observational study was conducted between January 2015 and September 2017. Data were obtained from pharmaceutical care visits: age, sex, previous treatments, reason for change and adverse effects (AE). Adherence was measured using the Morisky–Green tests.
Results One hundred and forty-seven patients were included (71.2% females), mean age was 42.4±11.5 years. Eighty-five patients were treated with TRF, 61 with DMF and 11 received sequential treatment with both drugs: 57,5% had received previous treatment. Reasons for switching treatment were: poor tolerance to parenteral administration (44%), disease progression (13.1%), skin lesions (9.5%), muscle aches (9.5%), flu-like syndrome (7.1%), gastrointestinal alterations (4.8%), JCV antibody positive (3.6%) and other causes (8.3%).
21.9% of the patients with DMF had been pretreated and 78.7% were adherent to treatment. 49.2% presented good tolerance. Main AE were: facial flushing (34.4%), gastrointestinal alterations (26.2%) and muscle pains (3.3%). DMF was discontinued in six patients and the reason was AE in three patients, disease progression in two and pregnancy in one. 35.6% of the patients with TRF had been pretreated and 90.6% were adherents. 64.7% presented good tolerance. Main AE were: alopecia (9.4%), gastrointestinal alterations (9.4%), blood pressure increase (4.7%), for skin reaction (4.7%) and muscle pains (3.5%). TRF was discontinued in eight patients and the reason was AE in four patients, disease progression in three and pregnancy in one.
Conclusion Main reason for switching treatment to new oral drugs is poor tolerance to injections, as oral route means an improvement over other routes of administration.
Dimethylfumarate and teriflunomide are drugs well tolerated by most of the patients interviewed.
Pharmaceutical care should be implemented in all patients with RRMS, in order to obtain more information about safety profile and improved adherence to new drugs.
No conflict of interest
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