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Leflunomide Exposure and Teriflunomide Concentrations up to the Third Trimester of Pregnancy: A Case Report

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References

  1. Pfaller B, Pupco A, Leibson T, Aletaha D, Ito S. A critical review of the reproductive safety of leflunomide. Clin Rheumatol. 2020;39(2):607–12. https://doi.org/10.1007/s10067-019-04819-4.

    Article  PubMed  Google Scholar 

  2. Fox RI, Herrmann ML, Frangou CG, et al. Mechanism of action for leflunomide in rheumatoid arthritis. Clin Immunol. 1999;93(3):198–208. https://doi.org/10.1006/clim.1999.4777.

    CAS  Article  PubMed  Google Scholar 

  3. Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Lopez-Jimenez J, Mirrasoul N, Salas E, Luo YJ, Jin S, Jones KL. Birth outcomes in women who have taken leflunomide during pregnancy. Arthritis Rheum. 2010;62(5):1494–503. https://doi.org/10.1002/art.27358.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bérard A, Zhao JP, Shui I, Colilla S. Leflunomide use during pregnancy and the risk of adverse pregnancy outcomes. Ann Rheum Dis. 2018;77(4):500–9. https://doi.org/10.1136/annrheumdis-2017-212078.

    CAS  Article  PubMed  Google Scholar 

  5. D’Aleo G, Rifici C, Donato A, et al. Twin pregnancy outcome following teriflunomide treatment in a relapsing-remitting multiple sclerosis patient: a case report. Medicine (Baltimore). 2020;99(28):e21212. https://doi.org/10.1097/MD.0000000000021212.

    Article  Google Scholar 

  6. Kieseier BC, Benamor M. Pregnancy outcomes following maternal and paternal exposure to teriflunomide during treatment for relapsing-remitting multiple sclerosis. Neurol Ther. 2014;3(2):133–8. https://doi.org/10.1007/s40120-014-0020-y.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vukusic S, Coyle PK, Jurgensen S, et al. Pregnancy outcomes in patients with multiple sclerosis treated with teriflunomide: Clinical study data and 5 years of post-marketing experience. Mult Scler. 2020;26(7):829–36. https://doi.org/10.1177/1352458519843055.

    Article  PubMed  Google Scholar 

  8. Sanofi-Aventis. clinical pharmacology and biopharmaceutics review: teriflunomide. FDA center for drug evaluation and research; https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202992Orig1s000ClinpharmR.pdf. Accessed 29 Apr 2021.

  9. O’Donnell EF, Saili KS, Koch DC, Kopparapu PR, Farrer D, Bisson WH, Mathew LK, Sengupta S, Kerkvliet NI, Tanguay RL, Kolluri SK. The anti-inflammatory drug leflunomide is an agonist of the aryl hydrocarbon receptor. PLoS ONE. 2010;5(10): e13128. https://doi.org/10.1371/journal.pone.0013128.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Hopkins AM, Wiese MD, Proudman SM, O’Doherty CE, Foster D, Upton RN. Semiphysiologically based pharmacokinetic model of leflunomide disposition in rheumatoid arthritis patients. CPT Pharmacometrics Syst Pharmacol. 2015;4(6):362–71. https://doi.org/10.1002/psp4.46.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Tomson T, Landmark CJ, Battino D. Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications. Epilepsia. 2013;54(3):405–14. https://doi.org/10.1111/epi.12109.

    CAS  Article  PubMed  Google Scholar 

  12. Arava. Product information. https://www.ema.europa.eu/en/documents/product-information/arava-epar-product-information_en.pdf. Accessed 29 Apr 2021.

  13. Loebstein R, Lalkin A, Koren G. Pharmacokinetic changes during pregnancy and their clinical relevance. Clin Pharmacokinet. 1997;33(5):328–43. https://doi.org/10.2165/00003088-199733050-00002.

    CAS  Article  PubMed  Google Scholar 

  14. Giles I, Yee CS, Gordon C. Stratifying management of rheumatic disease for pregnancy and breastfeeding. Nat Rev Rheumatol. 2019;15(7):391–402. https://doi.org/10.1038/s41584-019-0240-8.

    Article  PubMed  Google Scholar 

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Correspondence to Paul A. G. De Klaver.

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Paul A.G. de Klaver, Carolien M. Geesink, Jasper C.A. Broen and Luc J.J. Derijks declare no conflict of interest.

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The patient agreed to washout treatment in pregnancy and consented to publication of the case which was registered in the patient’s medical records.

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Authors contributions

Paul AG de Klaver, Carolien M Geesink, Jasper CA Broen and Luc JJ Derijks prepared the case report and approved the final draft.

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De Klaver, P.A.G., Geesink, C.M., Broen, J.C.A. et al. Leflunomide Exposure and Teriflunomide Concentrations up to the Third Trimester of Pregnancy: A Case Report. Clin Drug Investig 42, 787–789 (2022). https://doi.org/10.1007/s40261-022-01185-z

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