Safety liver profile of teriflunomide versus interferon β in multiple sclerosis: Systematic review and indirect comparison meta-analysis.

Highlights • As both teriflunomide and IFN β are similar in terms of effectiveness in the treatment of patients with RRMS, evaluation of safety profile can help the clinician to choose the most appropriate therapy. • All MS medications target the immune system and therefore have the theoretical potential to predispose patients to infection, to reduce surveillance of neoplasms, or to induce autoimmune disease, among other potential adverse effects. • Liver toxicity might be a reason for discontinuation of any drug prescribed, as it could potentially be a life-threating complication. • Elevated ALT is an indication of liver impairment particularly in acute cases, as drug-related liver failure, and is preferred over AST, as the former is more liver-specific while the latter is also produced by other tissues and can be increased in extrahepatic diseases. Abstract Objectives To compare the liver safety profile of interferon β (IFN β) and teriflunomide in patients with multiple sclerosis. Methods A network meta-analysis was carried out following the Cochrane Collaboration methodology. All trials comparing all types of IFN β with teriflunomide, or disease-modifying drugs, or placebo in RRMS were included. An indirect comparison network meta-analysis within a Bayesian framework with STATA (version 13.0) was done for this study. Results The database searches yielded 284 titles, with 15 records as duplicates. One study was identified by manually searching. Thirteen articles were included in the systematic review. Twelve studies compared IFN β (4203 patients) vs another DMT. Four studies evaluated the effectiveness and safety of teriflunomide (906 patients) vs another DMT. Six studies reported drug-induced liver injury as per the Hy's Law. However, only one study had a direct comparison and reported no cases of liver toxicity in either group, so it was not possible to estimate the OR. The indirect comparisons metanalysis shows that there was no statistically-significant difference between teriflunomide and IFN β (OR 1.09, 95% CI 0.02–2.16). Conclusions There were no significant difference when comparing IFN β and teriflunomide in terms of liver failure or elevation of transaminases. [ABSTRACT FROM AUTHOR]