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Review
, 310 (6), 475-483

Dimethyl Fumarate (DMF) vs. Monoethyl Fumarate (MEF) Salts for the Treatment of Plaque Psoriasis: A Review of Clinical Data

Affiliations
Review

Dimethyl Fumarate (DMF) vs. Monoethyl Fumarate (MEF) Salts for the Treatment of Plaque Psoriasis: A Review of Clinical Data

Lilla Landeck et al. Arch Dermatol Res.

Abstract

Fumarates (fumaric acid esters, FAEs) are orally administered systemic agents used for the treatment of psoriasis and multiple sclerosis. In 1994, a proprietary combination of FAEs was licensed for psoriasis by the German Drug Administration for use within Germany. Since then, fumarates have been established as one of the most commonly used treatments for moderate-to-severe psoriasis in Germany and other countries. The licensed FAE formulation contains dimethyl fumarate (DMF), as well as calcium, zinc, and magnesium salts of monoethyl fumarate (MEF). While the clinical efficacy of this FAE mixture is well established, the combination of esters on which it is based, and its dosing regimen, was determined empirically. Since the mid-1990s, the modes of action and contribution of the different FAEs to their overall therapeutic effect in psoriasis, as well as their adverse event profile, have been investigated in more detail. In this article, the available clinical data for DMF are reviewed and compared with data for the other FAEs. The current evidence substantiates that DMF is the main active compound, via its metabolic transformation to monomethyl fumarate (MMF). A recent phase III randomized and placebo-controlled trial including more than 700 patients demonstrated therapeutic equivalence when comparing the licensed FAE combination with DMF alone, in terms of psoriasis clearance according to the Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA). Thus, DMF as monotherapy for the treatment of psoriasis is as efficacious as in combination with MEF, making the addition of such fumarate derivatives unnecessary.

Keywords: DMF; Dimethyl fumarate; Fumaric acid esters; MEF; Monoethyl fumarate; Psoriasis.

Conflict of interest statement

Conflict of interest

LL has no conflicts of interest to declare. KA is a stock holder and former employee of Bayer AG and has received financial support and/or served as consultant, advisory board member, or speaker for AbbVie, Antabio, Almirall, EmertiPharma, Galderma, Leo, Loreal, Eli Lilly, and Novartis. IPC and AA are employees of Almirall S.A. UM has been an advisor and/or received speakers honoraria and/or received grants and/or participated in clinical trials of the following companies: AbbVie, Almirall, Amgen, Biogen, Boehringer-Ingelheim, Celgene, Dr. Reddy’s, Eli Lilly, Foamix, Formycon, Forward Pharma, Janssen, Leo Pharma, Medac, MSD, Novartis, VBL and Xenoport.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Percentages of patients achieving ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75; primary endpoint) at week 16 in the head-to-head DMF/FAE mixture comparator study [32]. Results are also shown for the secondary endpoints of 50% improvement (PASI 50) and 90% improvement (PASI 90). *p < 0.001 vs. placebo; **p < 0.0001 vs. placebo; p < 0.001 for noninferiority vs. Fumaderm. (Adapted from Mrowietz et al. [32])

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