Teriflunomide (Aubagio®): A Comprehensive Pharmacological and Clinical Review for the Management of Relapsing Multiple Sclerosis

Executive Summary

Teriflunomide is an oral, once-daily, first-line disease-modifying therapy (DMT) approved for the treatment of relapsing forms of multiple sclerosis (MS). As a small molecule drug, it represents a significant evolution from the injectable platform therapies that once dominated MS management. Its primary mechanism of action is the selective and reversible inhibition of dihydroorotate dehydrogenase (DHODH), a key mitochondrial enzyme in the de novo pyrimidine synthesis pathway. This action exerts a cytostatic effect on rapidly proliferating, activated T and B lymphocytes, which are central to the autoimmune pathogenesis of MS, thereby reducing neuroinflammation. The clinical efficacy of teriflunomide has been robustly established in pivotal Phase III trials, including TEMSO and TOWER, which demonstrated significant reductions in annualized relapse rates and a slowing of disability progression compared to placebo.