Teriflunomide (Aubagio)

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• Who can take teriflunomide (Aubagio)?
• How does teriflunomide (Aubagio) work?
• How well does teriflunomide (Aubagio) work?
• Teriflunomide (Aubagio) side effects
• Stopping teriflunomide (Aubagio)
• What tests do you need with teriflunomide (Aubagio)?
• Teriflunomide (Aubagio) and pregnancy, breastfeeding and contraception

Who can take teriflunomide (Aubagio)?

You can take teriflunomide (Aubagio) if you have active relapsing MS. ‘Active’ MS means you have relapses and/or MRI scans show that you have new, active or growing lesions.

You might be offered a ‘generic’ version of this DMT with a different brand name than Aubagio. This will work just as well as Aubagio.

Some health issues, like liver, kidney or blood problems, mean you can’t take this drug. Your MS team will check you for these before you start treatment.

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How does teriflunomide (Aubagio) work?

We don't know exactly how teriflunomide (Aubagio) works, but we know it dampens down inflammation. Your immune system makes cells, called T cells, that kill viruses and bacteria. But in MS these cells are believed to attack the coating (called myelin) around nerves in your brain and spinal cord. This drug stops T cells getting into your brain and spinal cord. So they can’t cause damage to the nerves there.

Teriflunomide is a tablet you take once a day.

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How well does teriflunomide (Aubagio) work?

The effectiveness of teriflunomide (Aubagio) is classed as ‘moderate’. Each DMT can be rated as ‘moderate’, ‘good’ or ‘high’ based on two things. One is how much it reduces relapses. The other is how much it slows down disability getting worse. 

An important early trial called TEMSO lasted for two years and reported its results in 2011:

In that trial… 

Relapses dropped by: 31% compared to placebo

This means that in the TEMSO trial, on average, people saw a 31% drop in the numbers of relapses they had. This was compared to people who took a placebo, a dummy treatment with no drug in it.

Disability getting worse was slowed by: 30% compared to placebo

In this trial, on average, people saw a 30% drop in the risk of their disability getting worse. This was compared to people who took a placebo.

How well does teriflunomide (Aubagio) work over many years?

One study in 2012 looked at people who had been on teriflunomide (Aubagio) for around eight years. The drug kept working and had no new risks that we didn’t already know about. Studies from 2016 and 2020 looked at people taking teriflunomide for between six and nine years. They also found the drug carried on working and there were no new side effects. 

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Teriflunomide (Aubagio) side effects

Compared to other DMTs, the risk of side effects from teriflunomide (Aubagio), especially serious ones, is among the lowest.

Very common side effects (more than 1 in 10 people get them):

• headache
• diarrhoea, feeling sick
• changes to liver enzymes, which will show up in blood tests
• hair thinning, but many people find it comes back after six months

Common side effects (up to 1 in 10 people get them):

• infections like flu, urinary tract infections, shingles or cold sores
• changes in blood tests, like a drop in white blood cells (lymphopenia) or red blood cells (anaemia)
• pins and needles, numbness or tingling
• feeling anxious
• increased blood pressure
• pain, such as muscle pain or joint pain
• rash or acne
• mild allergic reaction

Find out more about all the possible side effects of teriflunomide (Aubagio)

Stopping teriflunomide (Aubagio)

You should never stop taking a DMT without telling your neurologist. With some DMTs, if you suddenly stop, there’s a risk of ‘rebound’. This is when your MS gets much worse within a few weeks or months. This has happened with teriflunomide (Aubagio) but it’s not common.

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What tests do you need with teriflunomide (Aubagio)?

Before you start taking teriflunomide (Aubagio) and while you’re taking it, you’ll have your blood pressure taken regularly. You’ll have blood tests to check your liver, your white blood cells and blood platelets. You should have these tests every two weeks for the first six months, then every two months after that. 

Your neurologist might want you to have an MRI scan once a year to see if the drug is working. But how often you have scans depends on what your neurologist thinks you need. If your MS seems stable, you might have scans less often.

Vaccination

Like most DMTs, this drug makes infections more likely. Before you start it, your neurologist will check if you have protection against some of the infections it puts you at risk of. 

Your neurologist will check you’re up to date on your vaccines. This includes childhood ones like chickenpox (that vaccine protects you against shingles) and the MMR vaccine for measles, mumps and rubella. Some ‘live’ vaccines, like these two, aren’t safe to have once you’ve started many DMTs. Your MS team or GP can tell you whether a vaccine is ‘live’ or not. 

You’ll have any vaccines you need a few weeks before you start this drug. 

You can safely have the annual flu jab while taking this DMT. 

Read more about vaccines

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Teriflunomide (Aubagio) and pregnancy, breastfeeding and contraception

Pregnancy

Teriflunomide (Aubagio) might harm unborn babies. So, if you can get pregnant, you’ll need reliable contraception while on this drug to avoid a pregnancy. This means condoms, ‘the pill’, a coil, injections or an implant.

Teriflunomide (Aubagio) stays in the body far longer than other DMTs. If you want to get pregnant, you’ll need to wait until the drug leaves your body. The time this takes is called the ‘washout period’. For teriflunomide this can be up to two years. But you can take medication that speeds this up to under two months.

If you want to keep taking a DMT through your pregnancy, talk to your neurologist about switching to a different DMT. Or you and your doctor might decide that you’ll stop taking your DMT during your pregnancy, then restart it soon after the baby’s born.

If you’ve just had a baby, you could be more likely to have a relapse. So if you stop teriflunomide, your neurologist will advise you about when to start taking it again.

If you want to have a child, discuss this with your neurologist or MS nurse. If you think you’ve become pregnant, let your medical team know at once. Never stop your DMT without first getting their advice.

Breastfeeding

Teriflunomide (Aubagio) might pass into breast milk. So, if you want to breastfeed, you shouldn’t breastfeed your baby while taking this drug (and for however long your neurologist recommends after you stop taking it).

Contraception

If you can get pregnant, you must avoid this if you’re taking teriflunomide (Aubagio). You’ll need to use reliable contraception like condoms, ‘the pill’, a coil, injections or an implant. A woman who decides to stop taking it, for example to get pregnant, still needs contraception possibly for up to two years after her last dose. You can take treatment to speed this up, bringing the time needed down to under two months.

If you’re a man taking teriflunomide (Aubagio), it can be in your semen. Teriflunomide can also lower sperm counts. If you get a woman pregnant, this can affect the unborn baby. So you should use condoms while you’re on this drug. If you stop taking it, you’ll need to use condoms while you wait for the drug to leave your body. This is called the ‘washout period’. This lasts two years, but you can take a treatment to speed this up so it only takes a couple of months.

Your neurologist can give you more advice about contraception and fertility.

Read more about pregnancy, breastfeeding and contraception and DMTs

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