Background: Teriflunomide (TER) and dimethyl fumarate (DMF) have been approved as first-line oral treatments for relapsing-remitting multiple sclerosis (RRMS) in the United States and Europe. Therapeutic positioning of TER in RRMS management have not been fully established. Therefore, this study was aimed at directly comparing the efficacy and safety of these two drugs for treating RRMS by conducting a meta-analysis.
Methods: We searched MEDLINE, the Cochrane Library, and Igaku Chuo Zasshi databases for articles included until December 2020. The inclusion criterion was a clinical study comparing the efficacy and safety of TER and DMF in patients with RRMS.
Results: Among 263 relevant articles, 16 cohort studies were found eligible for inclusion in the meta-analysis. There were no significant differences between TER and DMF in total relapses (odds ratio, OR: 1.15 [95% confidence interval, 95% CI: 0.94-1.40]), Expanded Disability Status Scale progression (OR: 1.38 [95% CI: 0.80-2.39]), MRI activity (OR: 1.09 [95% CI: 0.63-1.88]), incidence of adverse events (OR: 0.83 [95% CI: 0.44-1.55]), and treatment discontinuation due to adverse events (OR: 0.90 [95% CI: 0.73-1.12]). The TER-associated rate of treatment discontinuation due to inefficacy (OR: 2.17 [95% CI: 1.85-2.53]) was significantly higher than that associated with DMF.
Conclusions: TER was as effective and safe as DMF, except for the rate of treatment discontinuation due to inefficacy. Thus, TER could be a treatment option for RRMS in Japan.