GPT and liver failure: All three of the recently approved oral DMTs have some kind of hepatotoxic profile identified in their phase III trials, such as elevated alanine aminotransferase tests three times the normal range in 6-7% of patients taking dimethyl fumarate (with no reported hepatic failure) [16,17], 7-19% for fingolimod [18,19], and 7-12% for teriflunomide [20,21].