In “Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology,” Rae-Grant et al. provided recommendations for use of disease-modifying therapy in patients with multiple sclerosis. Dr. Saltonstall, for Sanofi Genzyme, identified the following 3 concerns regarding teriflunomide in the recommendations: (1) characterization of teriflunomide as being transmitted in sperm and intercalating with DNA leading to teratogenicity unless treatment with chelation therapy is administered; (2) notation that teriflunomide should be switched to another agent if a person develops malignancy; and (3) indication that teriflunomide data are not Class I evidence.

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