Table 2.

Oral agents in RRMS: Overview of safety issues.

Drug	Side Effects	Saftey Precautions	Risk in pregnancy
Laquinimod	– Elevation of liver enzymes. – Abdominal and back pain, cough, dizziness, headache, diarrhea, respiratory tract infections.	– Monitoring for liver enzyme elevation and signs of infection,	– No data available
Fingolimod	– Skin malignancies. – Herpes infections. – Cardiac arrhythmia. – Macula edema. – Lymphopenia, influenza, nausea, headaches, increased liver enzymes, back pain, diarrhea.	– Close of vaccination gaps before treatment initiation => VZV!– During initiation of treatment monitoring for alterations of cardiac rhythm. – Monitor for macula edema and dermatological changes. – Monitoring of signs of infection. – Regular blood monitoring, including liver enzymes.	– Results of animal studies suggest teratogenic effects.
Teriflunomide	– Neutro- and lymphopenia. – Urinary tract infections and pyelonephritis. – increased liver enzymes, nausea, alopecia, nasopharyngitis, back pain, paresthesia, diarrhea, arthralgia.	– Regular blood monitoring, including liver enzymes. – Monitoring of signs of infection.	– Studies suggest an increased risk of fetal abnormalities.
Cladribine	– isolated malignancies. – Herpes zoster. – Lymphopenia, nausea, fatigue, respiratory tract infections, rash, depression, headache, nasopharyngitis.	– Regular blood monitoring. – Monitoring for signs of infection. – Monitoring for dermatological changes.	– Studies showed an increased teratogenic risk and frequency of fetal abnormalities.
BG-12	– Lymphopenia. – Abdominal pain, diarrhea, nausea, vomiting, proteinuria, pruritus, flushing.	– Regular blood monitoring. – Monitoring for signs of infection.	– No data in RRMS available. Experiences from psoriasis use showed no evidence for teratogenic effects.

Abbreviations: RRMS, relapsing remitting multiple sclerosis; VZV, varizella zoster virus.