Dimethyl fumarate titration for the systemic treatment of moderate-to-severe plaque psoriasis

Dimethyl Fumarate Treatment in Patients with Moderate-to-Severe Psoriasis: A 52-week Real-life Study

Abstract is missing (Short communication)

Dietary habits of psoriatic patients treated with dimethyl fumarate and drug-related side effects: results from an observational study

BACKGROUND

Despite its favorable long-term safety profile, side effects during dimethyl fumarate (DMF) treatment for psoriasis are not uncommon and may lead to treatment suspension. The association between side effects, especially gastrointestinal, and dietary habits has not yet been specifically addressed.

METHODS

This observational, cross-sectional study aimed to assess the dietary habits of patients with moderate-to-severe plaque psoriasis in treatment with DMF who attended three Italian psoriasis clinics. Demographic and clinical data, including any side effects, were collected from the patients' medical records. A self-administered questionnaire recorded and scored: 1) if meals are eaten regularly or not; 2) daily intake at meals of fatty foods, milk and dairy products, alcohol, fruit and vegetables; and 3) in the case of side effects, the time between eating and their onset.

RESULTS

We included 53 patients in treatment with DMF at a daily dose of 232.4±194.1 mg for 38±29.8 weeks. Thirty-eight (71.7%) reported side effects, namely flushing (60.5%), diarrhea (44.7%), gastralgia (29%) and nausea (15.8%). Overweight seemed associated with the occurrence of side effects. In 47.4% of subjects, side effects appeared within 2 hours of having a meal. Daily fat intake appeared to protect against side effects, albeit without statistical significance; skipping meals was correlated with their onset in subjects complaining of diarrhea.

CONCLUSIONS

Finding some correlation between dietary habits and occurrence of side effects during DMF treatment requires further investigation with the aim of developing possible strategies to improve its tolerability and retention rate.

Real-world use of dimehtyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus

Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderate-to-severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. Seven dermatology experts gathered online for three meetings to identify consensus on use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. Twenty statements were discussed and voted on using a facilitator-mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug–drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and slow titration schedule. Hematologic monitoring throughout treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on optimal use of DMF to treat psoriasis.

Efficacy and Safety of Dimethyl Fumarate in Patients with Moderate-to-Severe Plaque Psoriasis: DIMESKIN-2, a Multicentre Single-Arm Phase IIIb Study

This open-label multicentre trial evaluated the efficacy and safety of oral dimethyl fumarate (DMF) in patients with moderate-to-severe plaque psoriasis in real-life clinical practice over 52 weeks. Disease severity and improvement were assessed using the psoriasis area severity index (PASI), body surface area (BSA) affected, and Physician Global Assessment (PGA). Quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. The visual analogue scale (VAS) was used to quantify pruritus and measure treatment satisfaction. A total of 141 patients were included, being 66.7% male, aged 49.1 ± 14.7 years and with disease duration of 16 ± 12.1 years. After 52 weeks, mean PASI decreased from 15.9 ± 6.8 to 1.5 ± 2 and 87.7%, 56.9% and 24.6% of patients achieved PASI 75/90/100 response, respectively. BSA decreased from 26.5 ± 14.8% to 2.7 ± 3.5% at 52 weeks, and 81.5% of patients had a PGA 0-1. DLQI scores decreased from 9.4 ± 6.4 to 2.1 ± 3.3, and VAS of pruritus decreased from 53 ± 28.4 to 19.1 ± 26.2 at Week 52. VAS for treatment satisfaction was 79.4 ± 29.4 at Week 52. A total of 34.2% of patients had an AE leading to permanent discontinuation. These findings show that DMF can significantly improve indices of disease severity, pruritus and QoL, with high levels of patient satisfaction and similar safety profile to other fumarates.