ClinicSpeak: managing the initial problems with DMF

Did you tolerate DMF? Share your experiences. #ClinicSpeak #MSBlog #MSResearch

"The survey below demonstrates that MS healthcare professionals have developed their own strategies to manage and reduce the severity of gastrointestinal and flushing reactions when starting DMF (dimethyl fumarate - Tecfidera). The most important thing is to educate MSers about these initial side effects, or tolerance issues, and to make sure they understand that they are transitory and if you can get through the first 8 weeks they will disappear. The following is a strategic list of options available to us:
  1. Education, education, education: if you know what to expect the symptoms are never as bad if they are unexpected. Therefore you should expect to develop transient flushing, abdominal cramps, dyspepsia, nausea and diarrhoea when initially starting DMF.
  2. Dose titration; by starting with half-dose and increasing to full dose limits these symptoms
  3. Taking your medication with food reduces the side effects.
  4. If the symptoms are severe you can always take aspirin to limit the effects.
  5. Dose interruption, with intermittent dosing, can also be tried if the above fails. 
"I am aware that despite these measures some MSers can't get through the initial 8-12 weeks. However, the drop-off rate in real life is lower than what we saw in the clinical trials."
"Are there any DMF-users out there? You may want to share your own experiences with the readers and any strategies you found helpful in reducing the initial side effects."

From "Fix MS Now Blog" - Tecfidera

Phillips et al. Managing flushing and gastrointestinal events associated with delayed-release dimethyl fumarate: Experiences of an international panel.Mult Scler Relat Disord. 2014 ;3(4):513-9

Background: Strategies for monitoring and managing the known adverse event (AE) profile of therapies for relapsing-remitting MS have become key to the optimization of MSers outcomes.

The problem: Delayed-release dimethyl fumarate (DMF) was associated with an increased risk of flushing and gastrointestinal (GI) AEs in clinical trials. 

Method: A survey of clinicians with significant research experience using delayed-release DMF was conducted to provide guidance to clinicians using delayed-release DMF in clinical practice on the management of flushing and GI tolerability AEs. 

Outcome: Recommendations for prophylaxis included educating the MSer about flushing and GI AEs associated with delayed-release DMF and recommending administration with food. A variety of symptomatic treatments were utilized during the delayed-release DMF clinical trials in MSers presenting with delayed-release DMF-related flushing or GI AEs that were severe or bothersome enough to warrant pharmacological intervention.

CoI: multiple

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