Skip to main content
Top
Published in: Drugs 1/2018

01-01-2018 | Adis Drug Evaluation

Dimethyl Fumarate: A Review in Moderate to Severe Plaque Psoriasis

Author: Hannah A. Blair

Published in: Drugs | Issue 1/2018

Login to get access

Abstract

Fumaric acid esters (FAEs) have been used in the treatment of psoriasis in some European countries for over 20 years, and are recommended in the European guidelines for the management of moderate to severe plaque psoriasis. Dimethyl fumarate (Skilarence®; hereafter referred to as DMF) is an orally administered FAE indicated for the treatment of moderate to severe plaque psoriasis in adults in need of systemic medicinal therapy; unlike other available FAEs, it is not formulated in combination with monoethyl fumarate salts. EU approval was based on results of the phase III BRIDGE trial, and supported by previous publications of FAE preparations, including a combination of FAEs containing dimethyl fumarate and monoethyl fumarate salts (DMF/MEF; Fumaderm®). In the BRIDGE trial, DMF was superior to placebo in terms of the proportion of patients achieving a ≥ 75% improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) and a Physician Global Assessment score of 0 (clear) or 1 (almost clear) at week 16. DMF was also noninferior to DMF/MEF for PASI 75 at week 16. Patients receiving DMF also reported clinically meaningful improvements in body surface area involvement and health-related quality of life. The safety profile of DMF was similar to that of DMF/MEF, and no major or unexpected safety concerns were identified. The most common adverse events (flushing and gastrointestinal disorders) occurred mainly during the first few weeks of treatment. Currently available data indicate that DMF is an effective oral systemic treatment option for patients with moderate to severe plaque psoriasis.
Literature
1.
go back to reference Feldman SR, Goffe B, Rice G, et al. The challenge of managing psoriasis: unmet medical needs and stakeholder perspectives. Am Health Drug Benefits. 2016;9(9):504–13.PubMedPubMedCentral Feldman SR, Goffe B, Rice G, et al. The challenge of managing psoriasis: unmet medical needs and stakeholder perspectives. Am Health Drug Benefits. 2016;9(9):504–13.PubMedPubMedCentral
3.
go back to reference Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.CrossRefPubMed Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.CrossRefPubMed
4.
go back to reference Balak D. Fumaric acid esters in the management of psoriasis. Psoriasis Targ Ther. 2015;2015(1):9–23.CrossRef Balak D. Fumaric acid esters in the management of psoriasis. Psoriasis Targ Ther. 2015;2015(1):9–23.CrossRef
5.
go back to reference Okpara E. Dimethyl fumarate for moderate to severe chronic plaque psoriasis. Newcastle: Regional Drug & Therapeutics Centre; 2017. Okpara E. Dimethyl fumarate for moderate to severe chronic plaque psoriasis. Newcastle: Regional Drug & Therapeutics Centre; 2017.
6.
go back to reference Smith D. Fumaric acid esters for psoriasis: a systematic review. Ir J Med Sci. 2017;186(1):161–77.CrossRefPubMed Smith D. Fumaric acid esters for psoriasis: a systematic review. Ir J Med Sci. 2017;186(1):161–77.CrossRefPubMed
7.
go back to reference European Medicines Agency. Summary of product characteristics: Skilarence 30 mg gastro-resistant tablets, Skilarence 120 mg gastro-resistant tablets. 2017. http://www.ema.europa.eu. Accessed 8 Dec 2017. European Medicines Agency. Summary of product characteristics: Skilarence 30 mg gastro-resistant tablets, Skilarence 120 mg gastro-resistant tablets. 2017. http://​www.​ema.​europa.​eu. Accessed 8 Dec 2017.
9.
go back to reference Lehmann JC, Listopad JJ, Rentzsch CU, et al. Dimethylfumarate induces immunosuppression via glutathione depletion and subsequent induction of heme oxygenase 1. J Invest Dermatol. 2007;127(4):835–45.CrossRefPubMed Lehmann JC, Listopad JJ, Rentzsch CU, et al. Dimethylfumarate induces immunosuppression via glutathione depletion and subsequent induction of heme oxygenase 1. J Invest Dermatol. 2007;127(4):835–45.CrossRefPubMed
10.
go back to reference Gesser B, Johansen C, Rasmussen MK, et al. Dimethylfumarate specifically inhibits the mitogen and stress-activated kinases 1 and 2 (MSK1/2): possible role for its anti-psoriatic effect. J Invest Dermatol. 2007;127(9):2129–37.CrossRefPubMed Gesser B, Johansen C, Rasmussen MK, et al. Dimethylfumarate specifically inhibits the mitogen and stress-activated kinases 1 and 2 (MSK1/2): possible role for its anti-psoriatic effect. J Invest Dermatol. 2007;127(9):2129–37.CrossRefPubMed
11.
go back to reference Ockenfels HM, Schultewolter T, Ockenfels G, et al. The antipsoriatic agent dimethylfumarate immunomodulates T-cell cytokine secretion and inhibits cytokines of the psoriatic cytokine network. Br J Dermatol. 1998;139(3):390–5.CrossRefPubMed Ockenfels HM, Schultewolter T, Ockenfels G, et al. The antipsoriatic agent dimethylfumarate immunomodulates T-cell cytokine secretion and inhibits cytokines of the psoriatic cytokine network. Br J Dermatol. 1998;139(3):390–5.CrossRefPubMed
12.
go back to reference Onderdijk AJ, Balak DMW, Baerveldt EM, et al. Regulated genes in psoriatic skin during treatment with fumaric acid esters. Br J Dermatol. 2014;171(4):732–41.CrossRefPubMed Onderdijk AJ, Balak DMW, Baerveldt EM, et al. Regulated genes in psoriatic skin during treatment with fumaric acid esters. Br J Dermatol. 2014;171(4):732–41.CrossRefPubMed
13.
go back to reference Bovenschen HJ, Langewouters AM, van de Kerkhof PC. Dimethylfumarate for psoriasis: pronounced effects on lesional T-cell subsets, epidermal proliferation and differentiation, but not on natural killer T cells in immunohistochemical study. Am J Clin Dermatol. 2010;11(5):343–50.CrossRefPubMed Bovenschen HJ, Langewouters AM, van de Kerkhof PC. Dimethylfumarate for psoriasis: pronounced effects on lesional T-cell subsets, epidermal proliferation and differentiation, but not on natural killer T cells in immunohistochemical study. Am J Clin Dermatol. 2010;11(5):343–50.CrossRefPubMed
14.
15.
go back to reference Rostami-Yazdi M, Clement B, Schmidt TJ, et al. Detection of metabolites of fumaric acid esters in human urine: implications for their mode of action. J Invest Dermatol. 2009;129(1):231–4.CrossRefPubMed Rostami-Yazdi M, Clement B, Schmidt TJ, et al. Detection of metabolites of fumaric acid esters in human urine: implications for their mode of action. J Invest Dermatol. 2009;129(1):231–4.CrossRefPubMed
16.
go back to reference Rostami-Yazdi M, Clement B, Mrowietz U. Pharmacokinetics of anti-psoriatic fumaric acid esters in psoriasis patients. Arch Dermatol Res. 2010;302(7):531–8.CrossRefPubMed Rostami-Yazdi M, Clement B, Mrowietz U. Pharmacokinetics of anti-psoriatic fumaric acid esters in psoriasis patients. Arch Dermatol Res. 2010;302(7):531–8.CrossRefPubMed
17.
go back to reference Nast A, Boehncke WH, Mrowietz U, et al. German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res. 2012;304(2):87–113.CrossRefPubMed Nast A, Boehncke WH, Mrowietz U, et al. German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res. 2012;304(2):87–113.CrossRefPubMed
18.
go back to reference Mrowietz U, Szepietowski JC, Loewe R, et al. Efficacy and safety of LAS41008 (dimethyl fumarate) in adults with moderate-to-severe chronic plaque psoriasis: a randomized, double-blind, Fumaderm®- and placebo-controlled trial (BRIDGE). Br J Dermatol. 2017;176(3):615–23.CrossRefPubMed Mrowietz U, Szepietowski JC, Loewe R, et al. Efficacy and safety of LAS41008 (dimethyl fumarate) in adults with moderate-to-severe chronic plaque psoriasis: a randomized, double-blind, Fumaderm®- and placebo-controlled trial (BRIDGE). Br J Dermatol. 2017;176(3):615–23.CrossRefPubMed
19.
go back to reference Mrowietz U, Szepietowski J, Loewe R, et al. Clinical efficacy of LAS41008 (dimethyl fumarate) in pre-treated vs naive patients with moderate-to-severe chronic plaque psoriasis: post-hoc analysis of the BRIDGE study [abstract no. P1848 plus poster]. In: European Academy of Dermatology and Venerology. 2017. Mrowietz U, Szepietowski J, Loewe R, et al. Clinical efficacy of LAS41008 (dimethyl fumarate) in pre-treated vs naive patients with moderate-to-severe chronic plaque psoriasis: post-hoc analysis of the BRIDGE study [abstract no. P1848 plus poster]. In: European Academy of Dermatology and Venerology. 2017.
20.
go back to reference Mrowietz U, Szepietowski J, Loewe R, et al. LAS41008 (dimethyl fumarate) for psoriasis: analysis of the efficacy of treatment according to severity of disease at baseline [abstract no. P1846 plus poster]. In: European Academy of Dermatology and Venereology. 2017. Mrowietz U, Szepietowski J, Loewe R, et al. LAS41008 (dimethyl fumarate) for psoriasis: analysis of the efficacy of treatment according to severity of disease at baseline [abstract no. P1846 plus poster]. In: European Academy of Dermatology and Venereology. 2017.
21.
go back to reference Van de Kerkhof P, Szepietowski JC, Loewe R, et al. Treatment with LAS41008 (dimethyl fumarate) improves health-related quality of life and has a positive impact on the patient benefit index in adults with moderate-to-severe chronic plaque psoriasis: results of the BRIDGE study [abstract P1998 plus poster]. In: European Academy of Dermatology and Venerology. 2016. Van de Kerkhof P, Szepietowski JC, Loewe R, et al. Treatment with LAS41008 (dimethyl fumarate) improves health-related quality of life and has a positive impact on the patient benefit index in adults with moderate-to-severe chronic plaque psoriasis: results of the BRIDGE study [abstract P1998 plus poster]. In: European Academy of Dermatology and Venerology. 2016.
22.
go back to reference Altmeyer PJ, Matthes U, Pawlak F, et al. Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients. J Am Acad Dermatol. 1994;30(6):977–81.CrossRefPubMed Altmeyer PJ, Matthes U, Pawlak F, et al. Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients. J Am Acad Dermatol. 1994;30(6):977–81.CrossRefPubMed
23.
go back to reference Nieboer C, de Hoop D, van Loenen AC, et al. Systemic therapy with fumaric acid derivates: new possibilities in the treatment of psoriasis. J Am Acad Dermatol. 1989;20(4):601–8.CrossRefPubMed Nieboer C, de Hoop D, van Loenen AC, et al. Systemic therapy with fumaric acid derivates: new possibilities in the treatment of psoriasis. J Am Acad Dermatol. 1989;20(4):601–8.CrossRefPubMed
24.
go back to reference Nugteren-Huying WM, van der Schroeff JG, Hermans J, et al. Fumaric acid therapy for psoriasis: a randomized, double-blind, placebo-controlled study. J Am Acad Dermatol. 1990;22(2 Pt 1):311–2.CrossRefPubMed Nugteren-Huying WM, van der Schroeff JG, Hermans J, et al. Fumaric acid therapy for psoriasis: a randomized, double-blind, placebo-controlled study. J Am Acad Dermatol. 1990;22(2 Pt 1):311–2.CrossRefPubMed
25.
go back to reference Fallah Arani S, Neumann H, Hop WC, et al. Fumarates vs. methotrexate in moderate to severe chronic plaque psoriasis: a multicentre prospective randomized controlled clinical trial. Br J Dermatol. 2011;164(4):855–61.CrossRefPubMed Fallah Arani S, Neumann H, Hop WC, et al. Fumarates vs. methotrexate in moderate to severe chronic plaque psoriasis: a multicentre prospective randomized controlled clinical trial. Br J Dermatol. 2011;164(4):855–61.CrossRefPubMed
26.
go back to reference Nieboer C, de Hoop D, Langendijk PN, et al. Fumaric acid therapy in psoriasis: a double-blind comparison between fumaric acid compound therapy and monotherapy with dimethylfumaric acid ester. Dermatologica. 1990;181(1):33–7.CrossRefPubMed Nieboer C, de Hoop D, Langendijk PN, et al. Fumaric acid therapy in psoriasis: a double-blind comparison between fumaric acid compound therapy and monotherapy with dimethylfumaric acid ester. Dermatologica. 1990;181(1):33–7.CrossRefPubMed
27.
go back to reference Walker F, Adamczyk A, Kellerer C, et al. Fumaderm in daily practice for psoriasis: dosing, efficacy and quality of life. Br J Dermatol. 2014;171(5):1197–205.CrossRefPubMed Walker F, Adamczyk A, Kellerer C, et al. Fumaderm in daily practice for psoriasis: dosing, efficacy and quality of life. Br J Dermatol. 2014;171(5):1197–205.CrossRefPubMed
28.
go back to reference Inzinger M, Weger W, Heschl B, et al. Methotrexate vs. fumaric acid esters in moderate-to-severe chronic plaque psoriasis: data registry report on the efficacy under daily life conditions. J Eur Acad Dermatol Venereol. 2013;27(7):861–6.CrossRefPubMed Inzinger M, Weger W, Heschl B, et al. Methotrexate vs. fumaric acid esters in moderate-to-severe chronic plaque psoriasis: data registry report on the efficacy under daily life conditions. J Eur Acad Dermatol Venereol. 2013;27(7):861–6.CrossRefPubMed
29.
go back to reference Harries MJ, Chalmers RJ, Griffiths CE. Fumaric acid esters for severe psoriasis: a retrospective review of 58 cases. Br J Dermatol. 2005;153(3):549–51.CrossRefPubMed Harries MJ, Chalmers RJ, Griffiths CE. Fumaric acid esters for severe psoriasis: a retrospective review of 58 cases. Br J Dermatol. 2005;153(3):549–51.CrossRefPubMed
30.
go back to reference Brewer L, Rogers S. Fumaric acid esters in the management of severe psoriasis. Clin Exp Dermatol. 2007;32(3):246–9.CrossRefPubMed Brewer L, Rogers S. Fumaric acid esters in the management of severe psoriasis. Clin Exp Dermatol. 2007;32(3):246–9.CrossRefPubMed
31.
go back to reference Reich K, Thaci D, Mrowietz U, et al. Efficacy and safety of fumaric acid esters in the long-term treatment of psoriasis—a retrospective study (FUTURE). J Dtsch Dermatol Ges. 2009;7(7):603–11.PubMed Reich K, Thaci D, Mrowietz U, et al. Efficacy and safety of fumaric acid esters in the long-term treatment of psoriasis—a retrospective study (FUTURE). J Dtsch Dermatol Ges. 2009;7(7):603–11.PubMed
32.
go back to reference Thaci D, Weisenseel P, Philipp S, et al. Efficacy and safety of fumaric acid esters in patients with psoriasis on medication for comorbid conditions—a retrospective evaluation (FACTS). J Dtsch Dermatol Ges. 2013;11(5):429–35.PubMed Thaci D, Weisenseel P, Philipp S, et al. Efficacy and safety of fumaric acid esters in patients with psoriasis on medication for comorbid conditions—a retrospective evaluation (FACTS). J Dtsch Dermatol Ges. 2013;11(5):429–35.PubMed
33.
go back to reference Thio HB, van der Schroeff JG, Nugteren-Huying WM, et al. Long-term systemic therapy with dimethylfumarate and monoethylfumarate (Fumaderm®) in psoriasis. J Eur Acad Dermatol Venereol. 1995;4(1):35–40.CrossRef Thio HB, van der Schroeff JG, Nugteren-Huying WM, et al. Long-term systemic therapy with dimethylfumarate and monoethylfumarate (Fumaderm®) in psoriasis. J Eur Acad Dermatol Venereol. 1995;4(1):35–40.CrossRef
34.
go back to reference Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and side effects of 2 years of treatment. J Am Acad Dermatol. 1992;27(5 Pt 1):769–71.CrossRefPubMed Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and side effects of 2 years of treatment. J Am Acad Dermatol. 1992;27(5 Pt 1):769–71.CrossRefPubMed
35.
go back to reference Lijnen R, Otters E, Balak D, et al. Long-term safety and effectiveness of high-dose dimethylfumarate in the treatment of moderate to severe psoriasis: a prospective single-blinded follow-up study. J Dermatol Treat. 2016;27(1):31–6.CrossRef Lijnen R, Otters E, Balak D, et al. Long-term safety and effectiveness of high-dose dimethylfumarate in the treatment of moderate to severe psoriasis: a prospective single-blinded follow-up study. J Dermatol Treat. 2016;27(1):31–6.CrossRef
36.
go back to reference Balak DMW, Hajdarbegovic E, Bramer WM, et al. Progressive multifocal leukoencephalopathy associated with fumaric acid esters treatment in psoriasis patients. J Eur Acad Dermatol Venereol. 2017;31(9):1475–82.CrossRefPubMed Balak DMW, Hajdarbegovic E, Bramer WM, et al. Progressive multifocal leukoencephalopathy associated with fumaric acid esters treatment in psoriasis patients. J Eur Acad Dermatol Venereol. 2017;31(9):1475–82.CrossRefPubMed
37.
go back to reference Gieselbach RJ, Muller-Hansma AH, Wijburg MT, et al. Progressive multifocal leukoencephalopathy in patients treated with fumaric acid esters: a review of 19 cases. J Neurol. 2017;264(6):1155–64.CrossRefPubMed Gieselbach RJ, Muller-Hansma AH, Wijburg MT, et al. Progressive multifocal leukoencephalopathy in patients treated with fumaric acid esters: a review of 19 cases. J Neurol. 2017;264(6):1155–64.CrossRefPubMed
38.
go back to reference Reich K, Mrowietz U, Radtke MA, et al. Drug safety of systemic treatments for psoriasis: results from the German Psoriasis Registry PsoBest. Arch Dermatol Res. 2015;307(10):875–83.CrossRefPubMedPubMedCentral Reich K, Mrowietz U, Radtke MA, et al. Drug safety of systemic treatments for psoriasis: results from the German Psoriasis Registry PsoBest. Arch Dermatol Res. 2015;307(10):875–83.CrossRefPubMedPubMedCentral
39.
go back to reference Hoefnagel JJ, Thio HB, Willemze R, et al. Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis. Br J Dermatol. 2003;149(2):363–9.CrossRefPubMed Hoefnagel JJ, Thio HB, Willemze R, et al. Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis. Br J Dermatol. 2003;149(2):363–9.CrossRefPubMed
40.
go back to reference Nast A, Gisondi P, Ormerod AD, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris—update 2015—short version—EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol. 2015;29(12):2277–94.CrossRefPubMed Nast A, Gisondi P, Ormerod AD, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris—update 2015—short version—EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol. 2015;29(12):2277–94.CrossRefPubMed
41.
go back to reference Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61(3):451–85.CrossRefPubMed Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61(3):451–85.CrossRefPubMed
42.
go back to reference Zweegers J, de Jong EM, Nijsten TE, et al. Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology. Dermatol Online J. 2014;20(3). Zweegers J, de Jong EM, Nijsten TE, et al. Summary of the Dutch S3-guidelines on the treatment of psoriasis 2011. Dutch Society of Dermatology and Venereology. Dermatol Online J. 2014;20(3).
43.
go back to reference Arnold T, Schaarschmidt ML, Herr R, et al. Drug survival rates and reasons for drug discontinuation in psoriasis. J Dtsch Dermatol Ges. 2016;14(11):1089–99.CrossRefPubMed Arnold T, Schaarschmidt ML, Herr R, et al. Drug survival rates and reasons for drug discontinuation in psoriasis. J Dtsch Dermatol Ges. 2016;14(11):1089–99.CrossRefPubMed
44.
go back to reference Ismail N, Collins P, Rogers S, et al. Drug survival of fumaric acid esters for psoriasis: a retrospective study. Br J Dermatol. 2014;171(2):397–402.CrossRefPubMed Ismail N, Collins P, Rogers S, et al. Drug survival of fumaric acid esters for psoriasis: a retrospective study. Br J Dermatol. 2014;171(2):397–402.CrossRefPubMed
45.
go back to reference Sticherling M, Mrowietz U, Augustin M, et al. Secukinumab is superior to fumaric acid esters in treating patients with moderate-to-severe plaque psoriasis who are naive to systemic treatments: results from the randomized controlled PRIME trial. Br J Dermatol. 2017;177(4):1024–32.CrossRefPubMed Sticherling M, Mrowietz U, Augustin M, et al. Secukinumab is superior to fumaric acid esters in treating patients with moderate-to-severe plaque psoriasis who are naive to systemic treatments: results from the randomized controlled PRIME trial. Br J Dermatol. 2017;177(4):1024–32.CrossRefPubMed
46.
go back to reference Schmitt J, Zhang Z, Wozel G, et al. Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol. 2008;159(3):513–26.CrossRefPubMed Schmitt J, Zhang Z, Wozel G, et al. Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol. 2008;159(3):513–26.CrossRefPubMed
Metadata
Title
Dimethyl Fumarate: A Review in Moderate to Severe Plaque Psoriasis
Author
Hannah A. Blair
Publication date
01-01-2018
Publisher
Springer International Publishing
Published in
Drugs / Issue 1/2018
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.1007/s40265-017-0854-6

Other articles of this Issue 1/2018

Drugs 1/2018 Go to the issue