Dimethyl fumarate

Basic information
Side-effects: GI, flushing, low WBC

Contra-indications: low lymphocyte count, severe infection, severe GI disease

Efficacy : ARR 40% for relapse rate, 30% for disability worsening, after 2 years, in RRMS against placebo

Monitoring
FBC every 3 months, LFTs and U+Es every 6 months, MRI brain every 12 months
 * Stop if lymphocytes <0.5 for more than 6 months because of risk of PML
 * Reassess risk benefit if lymphocytes <0.8 for more than 6 months

Stopping criteria

 * no reduction in relapse rate or severity cf. pre-treatment
 * unable to walk due to MS
 * pregnant or trying to become so

Links

 * BNF entry
 * Summary of Product Characteristics (SmPC)
 * Cochrane review 2015