PMID- 27042079
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160404
LR  - 20240324
IS  - 1176-6336 (Print)
IS  - 1178-203X (Electronic)
IS  - 1176-6336 (Linking)
VI  - 12
DP  - 2016
TI  - Dimethyl fumarate in the management of multiple sclerosis: appropriate patient 
      selection and special considerations.
PG  - 339-50
LID - 10.2147/TCRM.S85099 [doi]
AB  - Delayed-release dimethyl fumarate (DMF), also known as gastroresistant DMF, is 
      the most recently approved oral disease-modifying treatment (DMT) for relapsing 
      multiple sclerosis. Two randomized clinical trials (Determination of the Efficacy 
      and Safety of Oral Fumarate in Relapsing-Remitting MS [DEFINE] and Comparator and 
      an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis [CONFIRM]) 
      demonstrated significant efficacy in reducing relapse rate and radiological signs 
      of disease activity, as seen on magnetic resonance imaging. The DEFINE study also 
      indicated a significant effect of DMF on disability worsening, while the low 
      incidence of confirmed disability worsening in the CONFIRM trial rendered an 
      insignificant reduction among the DMF-treated groups when compared to placebo. 
      DMF also demonstrated a good safety profile and acceptable tolerability, since 
      the most common side effects (gastrointestinal events and flushing reactions) are 
      usually transient and mild to moderate in severity. Here, we discuss the place in 
      therapy of DMF for individuals with relapsing multiple sclerosis, providing a 
      tentative therapeutic algorithm to manage newly diagnosed patients and those who 
      do not adequately respond to self-injectable DMTs. Literature data supporting the 
      potential role of DMF as a first-line therapy are presented. The possibility of 
      using DMF as switching treatment or even as an add-on strategy in patients with 
      breakthrough disease despite self-injectable DMTs will also be discussed. Lastly, 
      we argue about the role of DMF as an exit strategy from natalizumab-treated 
      patients who are considered at risk for developing multifocal progressive 
      leukoencephalopathy.
FAU - Prosperini, Luca
AU  - Prosperini L
AD  - Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
FAU - Pontecorvo, Simona
AU  - Pontecorvo S
AD  - Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20160302
PL  - New Zealand
TA  - Ther Clin Risk Manag
JT  - Therapeutics and clinical risk management
JID - 101253281
PMC - PMC4780395
OTO - NOTNLM
OT  - dimethyl fumarate
OT  - multiple sclerosis
OT  - oral drugs
OT  - therapeutic algorithm
EDAT- 2016/04/05 06:00
MHDA- 2016/04/05 06:01
PMCR- 2016/03/02
CRDT- 2016/04/05 06:00
PHST- 2016/04/05 06:00 [entrez]
PHST- 2016/04/05 06:00 [pubmed]
PHST- 2016/04/05 06:01 [medline]
PHST- 2016/03/02 00:00 [pmc-release]
AID - tcrm-12-339 [pii]
AID - 10.2147/TCRM.S85099 [doi]
PST - epublish
SO  - Ther Clin Risk Manag. 2016 Mar 2;12:339-50. doi: 10.2147/TCRM.S85099. eCollection 
      2016.