Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study

J Neurol. 2018 Aug;265(8):1850-1859. doi: 10.1007/s00415-018-8916-6. Epub 2018 Jun 14.


Background: Dimethyl-fumarate (DMF) demonstrated efficacy and safety in relapsing-remitting multiple sclerosis (MS) in randomized clinical trials.

Objectives: To track and evaluate post-market DMF profile in real-world setting.

Materials and methods: Patients receiving DMF referred to Italian MS centres were enrolled and prospectively followed, collecting demographic clinical and radiological data.

Results: Among the 735 included patients, 45.4% were naïve to disease-modifying therapies, 17.8% switched to DMF because of tolerance, 27.4% switched to DMF because of lack of efficacy, and 9.4% switched to DMF because of safety concerns. Median DMF exposure was 17 months (0-33). DMF reduced the annual relapse rate (ARR) by 63.2%. At 12 and 24 months, 85 and 76% of patients were relapse-free. NEDA-3 status after 12 months of DMF treatment was maintained by 47.5% of patients. 89 and 70% of patients at 12 and 24 months regularly continued DMF. Most frequent adverse events (AEs) were flushing (37.2%) and gastro-enteric AEs (31.1%).

Conclusion: Our post-market study corroborated that DMF is a safe and effective drug. Additionally, the study suggested that naïve patients strongly benefit from DMF and that DMF improved ARR also in patients who were horizontally switched from injectable therapies due to tolerability and efficacy issues.

Keywords: DMF; Dimethyl fumarate; MS; Multiple sclerosis; Real-life study; Real-world study.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Dimethyl Fumarate / adverse effects*
  • Dimethyl Fumarate / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use*
  • Italy
  • Male
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy
  • Prospective Studies
  • Treatment Outcome
  • Young Adult


  • Immunosuppressive Agents
  • Dimethyl Fumarate