What is Aubagio (Teriflunomide)?
Aubagio, with the active ingredient teriflunomide, is an oral, once-daily disease-modifying therapy (DMT) used to treat relapsing forms of multiple sclerosis (MS) in adults and children aged 10 and older [1.8.3, 1.8.4]. As an immunomodulatory agent, its primary role is to reduce the frequency of MS relapses and delay the progression of physical disability [1.6.5]. The exact way teriflunomide works in MS is not fully understood, but it is known to be a pyrimidine synthesis inhibitor [1.6.2]. It acts on a mitochondrial enzyme called dihydroorotate dehydrogenase, which is crucial for the creation of new DNA in rapidly dividing cells [1.6.1, 1.6.2]. By inhibiting this enzyme, Aubagio reduces the number of activated B-cells and T-cells—types of white blood cells that are key players in the inflammatory attacks on the central nervous system in MS [1.6.4, 1.6.5]. This reduction in active lymphocytes helps to control the underlying inflammation of the disease [1.6.1].
The Direct Link: Aubagio and Mouth Sores
Yes, Aubagio can cause mouth sores. This side effect is officially recognized and listed in patient medication guides and medical resources [1.2.2, 1.3.1]. These sores can manifest as painful ulcers in the mouth and throat [1.2.1, 1.2.5]. While not among the most common side effects like diarrhea or hair loss, which can affect up to 18% and 13% of users respectively, oral ulcers are a notable adverse reaction [1.3.3].
The development of mouth sores (aphthous stomatitis) is sometimes associated with medications that affect the immune system or rapidly dividing cells [1.3.1]. Because the lining of the mouth consists of cells that turn over quickly, it can be susceptible to the effects of drugs like teriflunomide that inhibit cell proliferation. In severe cases, mouth sores can be a symptom of a more serious, though rare, systemic skin reaction like Stevens-Johnson syndrome (SJS) [1.2.3, 1.4.2]. It is crucial for patients experiencing mouth sores, especially if accompanied by fever, rash, or blistering, to contact their doctor immediately [1.2.2, 1.4.2].
Managing Aubagio-Related Mouth Sores
If you develop mouth sores while taking Aubagio, several strategies can help manage the discomfort and promote healing. It is essential to first consult your healthcare provider to confirm the cause and rule out more serious complications.
At-Home and Over-the-Counter (OTC) Care
- Maintain Gentle Oral Hygiene: Use a soft-bristled toothbrush to avoid further irritation [1.5.6]. Some sources recommend using toothpaste free of sodium lauryl sulphate, which can be an irritant [1.5.6].
- Dietary Adjustments: Avoid foods and drinks that can aggravate sores, such as those that are hot, spicy, salty, or acidic (like citrus fruits) [1.5.1, 1.5.2].
- Soothing Rinses: Gargling with cool water or a warm saltwater solution (half a teaspoon of salt in a glass of warm water) can soothe discomfort [1.5.1, 1.5.3]. An antiseptic mouthwash containing chlorhexidine may also be recommended by a pharmacist to speed healing and prevent infection, though it can cause temporary staining [1.5.3, 1.5.6].
- Topical Anesthetics: OTC products containing benzocaine or similar anesthetics can provide temporary pain relief [1.5.1, 1.5.4]. These are available as gels or rinses.
When to Involve a Doctor
While mild sores may resolve with at-home care, you should contact your doctor promptly if:
- The sores are unusually large, numerous, or persistent (lasting longer than two weeks) [1.5.3].
- You experience severe pain that interferes with eating or drinking.
- The mouth sores are accompanied by other symptoms like fever, skin rash, blistering, or peeling skin. These could be signs of a severe reaction like SJS or DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) and require immediate medical attention [1.2.2, 1.3.1].
Your doctor might prescribe topical corticosteroids or other anti-inflammatory preparations to reduce pain and inflammation [1.5.5]. In cases of severe or persistent sores, they will re-evaluate your treatment plan.
Comparison of Oral Side Effects in MS Medications
Oral side effects are not unique to Aubagio. A study reviewing medications for MS found 18 different types of oral side effects, with dry mouth (xerostomia), taste alteration (dysgeusia), and mouth ulceration being among the most noted [1.7.1, 1.7.2].
| Medication | Common Oral/Facial Side Effects | Class/Type |
|---|---|---|
| Aubagio (teriflunomide) | Mouth ulcers, oral herpes, toothache [1.3.2, 1.4.3] | Oral DMT |
| Tecfidera (dimethyl fumarate) | Flushing, gastrointestinal issues (diarrhea, nausea) [1.7.5] | Oral DMT |
| Gilenya (fingolimod) | May cause sinus or throat infections; oral ulcers not a primary side effect | Oral DMT |
| Mavenclad (cladribine) | Headaches, nausea, potential for oral herpes infections [1.7.3] | Oral Short-Course DMT |
| Interferons (e.g., Rebif, Avonex) | Flu-like symptoms, which can include sore throat | Injectable DMT |
This table illustrates that while different DMTs have distinct side effect profiles, issues affecting the mouth and throat are a possibility with several treatments, particularly those impacting the immune system.
Conclusion
Aubagio (teriflunomide) is an effective medication for managing relapsing forms of MS, but it carries the potential for side effects, including the development of mouth sores [1.3.1]. While this is a less common reaction compared to side effects like hair thinning or diarrhea, it can be painful and concerning for patients [1.3.3]. Understanding the potential for this side effect allows for better preparation and management. Patients should practice good oral hygiene, make sensible dietary choices, and use OTC remedies for mild cases [1.5.1, 1.5.6]. Most importantly, maintaining open communication with a healthcare provider is key. Any instance of mouth sores, especially if severe or accompanied by other systemic symptoms, warrants immediate medical consultation to ensure safety and proper care while managing multiple sclerosis.
For more detailed information on medication management, consult a medical professional. An authoritative resource on medication side effects is the U.S. Food & Drug Administration (FDA).
