Real-Word Effectiveness and Safety of Dimethyl Fumarate in a Multiple Sclerosis Portuguese Population

Safety and Discontinuation Rate of Dimethyl Fumarate (Zadiva®) in Patients with Multiple Sclerosis: An Observational Retrospective Study

BACKGROUND

This study evaluates the real-world safety and discontinuation rate of Zadiva® (generic product of dimethyl fumarate (DMF)) in Iranian patients with relapsing-remitting multiple sclerosis (RRMS), supplementing existing clinical evidence from randomized controlled trials.

METHODS

This retrospective observational study evaluated the real-world safety and discontinuation rate of DMF in RRMS patients from Amir A'lam referral hospital's neurology clinic. Data on safety, discontinuation rate, and clinical disease activity were collected retrospectively. The study aimed to assess the discontinuation rate, safety, and reasons for discontinuation, as well as the number of patients experiencing a relapse, MRI activity, and EDSS scores.

RESULTS

In total, 142 RRMS patients receiving DMF were included in the study, with 15 discontinuing treatment due to adverse events, lack of efficacy, or pregnancy. Notably, a significant reduction in relapse rates was observed, with 90.8% of patients remaining relapse-free throughout the study period. After 1 year of treatment with Zadiva®, only 17.6% of patients experienced MRI activity, whereas the EDSS score remained stable.

CONCLUSIONS

This study provides important real-world data on the safety and tolerability of Zadiva® in RRMS patients. The results indicate that Zadiva® is generally well tolerated and safe, with a low discontinuation rate due to adverse events or lack of efficacy. These findings suggest that Zadiva® is an effective and safe treatment option for RRMS patients in real-world practice.

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

Dimethyl fumarate (DMF) is a widely used oral disease-modifying therapy for multiple sclerosis (MS). Its efficacy and safety profiles are supported by over a decade of experience. Differences exist between Asia and Europe/United States in the prevalence and characteristics of MS; most data for DMF are derived from populations outside Asia. DMF was recently (2021) approved for use in China. The objectives of this review were to evaluate the evidence for DMF's profile, to provide an update to healthcare providers on current knowledge surrounding its use and to assess the relevance of existing data to use in China. This study used a modified Delphi method based on the insights of a scientific Steering Committee (SC), with a structured literature review conducted to assess the data of DMF. The literature review covered all papers in English (from 01 January 2011 to 21 February 2022) that include 'dimethyl fumarate' and 'multiple sclerosis', and their MeSH terms, on PubMed, supplemented by EMBASE and Citeline searches. Papers were categorized by topic and assessed for relevance and quality, before being used to formulate statements summarizing the literature on each subject. SC members voted on/revised statements, requiring ⩾80% agreement and ⩽10% disagreement for inclusion. Statements not reaching this level were discussed further until agreement was reached or until there was agreement to remove the statement. A total of 1030 papers were retrieved and used to formulate the statements and evidence summaries considered by the SC members. A total of 45 statements were agreed by the SC members. The findings support the positive efficacy and safety profile of DMF in treating patients with MS. Limited Chinese patient data are an ongoing consideration; however, based on current evidence, the statements are considered applicable to both the global and Chinese populations. DMF is a valuable addition to address unmet MS treatment needs in China. Registration: Not applicable.

Dimethyl Fumarate in Multiple Sclerosis Patients: A Real World Study

Amaç: Çalışmamızda dimetil fumarat (DMF) kullanan ya da daha önce kullanmış olan ataklı multipl skleroz (MS) hastalarında etkinlik ve güvenlik verilerinin elde edilmesi amaçlandı. Yöntem: Çalışma gözlemsel retrospektif kohort çalışması olarak tasarlandı. İstanbul Tıp Fakültesi Nöroloji Ana Bilim Dalında takip edilen ve 2014–2021 yılları arasında DMF kullanmış ataklı yineleyici (RRMS) ve ataklı progresif (RPMS) MS hastalarının verileri incelendi. Hastalarda DMF başlandıktan sonraki ilk genişletilmiş özürlülük durum ölçeği (EDSS) kötüleşmesi, ilk atak ve ilk yeni MRG lezyonu bilgileri elde edilerek hastalık aktivitesi olmaması durumu (NEDA-3) belirlendi. Bulgular: Toplam 126 ataklı MS hastası (85 kadın, 41 erkek; 116 RRMS, 10 RPMS) çalışmaya dahil edildi. DMF öncesi başka bir tedavi kullanmış olan, ataklı progresif olan ve DMF öncesi hastalık süresi daha uzun olan hastalarda DMF daha yüksek oranda kesilmişti (p=0,002, p=0,03 ve p=0,002). Beyin MRG bilgisi olan 65 RRMS ve RPMS tanılı hastanın %25’inde DMF başlandıktan sonraki takip döneminde NEDA-3 durumu sağlandığı görüldü. DMF öncesinde EDSS skorunun 3’ün altında olması NEDA-3 durumunun yitimine, ilk atağa ve ilk özürlülük birikiminin olmasına kadar geçen süreleri anlamlı ölçüde uzattı (NEDA-3 için p=0,008, HR=1,95). Sonuç: Çalışmamızda elde edilen gerçek yaşam verileri güncel bilgiler ile büyük oranda benzerlik göstermektedir. Elde ettiğimiz bulgular EDSS skoru 3’ün altında olan hastalarda başlanan DMF’nin atak, yeni beyin MRG lezyonu ve engellilik birikimi gelişme riskinin azalttığına işaret etmektedir.