Introducing a simplified titration scheme for dimethylfumarate (DMF) in patients with moderate-to-severe psoriasis: a case series

Abstract

Dimethylfumarate (DMF) is approved for the treatment of moderate to severe psoriasis. In clinical practice, DMF tolerability is improved by slowly up-titrating the dose. Time-to-onset of gastrointestinal complaints (a common adverse event [AE]) is ∼4 weeks, coinciding with the increase in dose to one 120-mg tablet. The average DMF dose during maintenance treatment is also often lower than the maximum indicated dose of 720 mg/day. Here, a simplified dose-escalation strategy is described, where twice-daily DMF was up-titrated to a maximum of 720 mg/day (if required) in week 7. Ten patients received DMF according to the new scheme (maximum dose: 720 mg/day [n = 5], 480 mg/day [n = 3; escalation halted early due to good efficacy], and ≤240 mg/day [n = 2] by week 12). Mean Psoriasis Area Severity Index (PASI) decreased from 7.2 to 0.9 between weeks 0 and 24. Absolute Psoriasis Area Severity Index (aPASI) was ≤3 for 7 and 6 patients at weeks 12 and 24, respectively. Affected BSA and DLQI demonstrated similar improvements. Treatment was terminated in 3 patients due to AEs (diarrhea and lymphopenia). In this case series, simplified DMF dosing was largely well-tolerated and provided similar efficacy to the current scheme. Higher doses were reached more quickly and the dosing regimen was simpler for patients (twice instead of three times daily).

Keywords:

• Dimethylfumarate
• dosing scheme
• psoriasis
• dose-titration

Ethical approval

All patients were informed of and agreed to the change to the titration schedule.

Disclosure statement

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. RvK has been an investigator, consultant, advisor or speaker for AbbVie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, Eli Lilly, GSK, Leo, Janssen-Cilag, Medac, MSD, Novartis, Pfizer, UCB and VBL. SD is an employee of Almirall Hermal GmbH, Reinbek, Germany.

Data availability statement

All data generated or analyzed during this study are included in the published article.

Acknowledgments

The authors thank Hannah Clarke, Ph.D., and Jilly Hope, Ph.D., of Bioscript Group, Macclesfield, UK for medical writing assistance in the preparation of this article. Support for this assistance was given by Almirall Hermal GmbH.