Dimethyl Fumarate (Tecfidera®) is the third oral therapy approved for use in for relapsing-remitting multiple sclerosis (RRMS). It is thought to cause an induction of helper cytokines which causes apoptosis (cell death) in activated T cells. Additionally, it affects adhesion molecules which results in decrease of lymphocytes movement into the central nervous system. In two clinical trials—DEFINE (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing–Remitting MS) and CONFIRM (Comparator and an Oral Fumarate in Relapsing–Remitting MS)—dimethyl fumarate reduced MS relapse rates by approximately 50% over placebo and reduced the progression of disability by about 30%. The recommended starting dose for dimethyl fumarate is 120 mg twice a day orally. After 7 days, the dose should be increased to the maintenance dose of 240 mg twice a day orally. The main side effects of dimethyl fumarate include gastrointestinal symptoms (nausea, abdominal pain, vomiting, and diarrhea) and skin flushing. Dimethyl fumarate can be taken with or without food. Administration with food may reduce the incidence of flushing These adverse effects decrease over time Recommended safety monitoring includes complete blood count prior to treatment and annually while on treatment. Dimethyl fumarate is an attractive option for first-line treatment, breakthrough disease activity, intolerance to other therapies, and possibly natalizumab-treated patients with positive JC virus serology. Individuals who have questions about Dimethyl Fumarate (Tecfidera) should contact their healthcare provider.
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Updated: November 2014