Real-life persistence and tolerability with dimethyl fumarate

Mult Scler Relat Disord. 2018 Aug;24:42-46. doi: 10.1016/j.msard.2018.05.007. Epub 2018 Jun 2.


Background: Dimethyl fumarate (DMF) has been registered for the treatment of relapsing-remitting multiple sclerosis (RRMS). Differences in tolerability between multiple sclerosis clinics in patients treated with DMF has not been examined.

Aim: We examined real-world tolerability to DMF, and also compared adherence data between two MS clinics.

Methods: Adverse events (AE), discontinuation rates, and causes of discontinuation were investigated.

Results: 253 patients participated in this retrospective study. In the total cohort, 27.7% of the patients discontinued DMF. Higher rate of discontinuation was associated with higher number of previous disease modifying treatments (p < 0.001). Reasons for discontinuation were primarily flushing (15%) and gastrointestinal AEs (51%). Grade III lymphopenia was detected only in 6 cases (2.4%). We observed differences between the two clinics: discontinuation because of AEs was different (Odds ratio 6.13, 95% CI: 3.0-12.7, p < 0.001), the mean treatment duration also differed (305.3 ± 186.3 vs 140.5 ± 114.4 days, p < 0.001), and dissimilarities in adherence were mainly related to flushing, gastrointestinal AEs, and consideration of lymphopenia (p < 0.0001). Better adherence was associated with prospectively planned management of gastrointestinal AEs and flushing.

Conclusion: Adherence in real-life was similar to pivotal trials. Differences in discontinuation rates at two MS clinics underline importance of AE management.

Keywords: Adherence; Dimethyl fumarate; Lymphopenia; Management; Monitoring; Multiple sclerosis; Tolerability.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Dimethyl Fumarate / adverse effects*
  • Dimethyl Fumarate / therapeutic use
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy
  • Patient Acceptance of Health Care
  • Retrospective Studies


  • Immunosuppressive Agents
  • Dimethyl Fumarate