Moderate to severe plaque psoriasis

Active Ingredient: Dimethyl fumarate

Indication for Dimethyl fumarate

Population group: only adults (18 years old or older)
Therapeutic intent: Curative procedure

Dimethyl fumarate is indicated for the treatment of moderate to severe plaque psoriasis in adults in need of systemic medicinal therapy.

For this indication, competent medicine agencies globally authorize below treatments:

30 mg once daily with subsequent gradual increases up to 720 mg total daily dose

For:

Dosage regimens

Oral, 30 milligrams dimethyl fumarate, once daily at evening, over the duration of 1 week. Afterwards, oral, 30 milligrams dimethyl fumarate, 2 times daily, over the duration of 1 week. Afterwards, oral, 30 milligrams dimethyl fumarate, 3 times daily, over the duration of 1 week. Afterwards, oral, 120 milligrams dimethyl fumarate, once daily at evening, over the duration of 1 week. Afterwards, oral, 120 milligrams dimethyl fumarate, 2 times daily, over the duration of 1 week. Afterwards, oral, 120 milligrams dimethyl fumarate, 3 times daily, over the duration of 1 week. Afterwards, oral, 480 milligrams dimethyl fumarate, divided 3 times daily, over the duration of 1 week. Afterwards, oral, 600 milligrams dimethyl fumarate, divided 3 times daily, over the duration of 1 week. Afterwards, oral, 240 milligrams dimethyl fumarate, 3 times daily.

Detailed description

To improve tolerability, it is recommended to begin treatment with a low initial dose with subsequent gradual increases. In the first week, a 30 mg dose is taken once daily (1 tablet in the evening). In the second week, a 30 mg dose is taken twice daily (1 tablet in the morning and 1 in the evening). In the third week, a 30 mg dose is taken three times daily (1 tablet in the morning, 1 at midday, and 1 in the evening). From the fourth week, treatment is switched to only 1 tablet of a 120 mg dose in the evening. This dose is then increased by one 120 mg tablet per week at different times of day for the subsequent 5 weeks, as shown in the table below. The maximum daily dose allowed is 720 mg (six 120 mg tablets).

WeekNumber of tabletsTotal daily dose (mg) of dimethyl fumarate
MorningMiddayEvening
Dimethyl fumarate 30 mg
100130
210160
311190
Dimethyl fumarate 120 mg
4001120
5101240
6111360
7112480
8212600
9+222720

If a particular dose increase is not tolerated, it may be temporarily reduced to the last tolerated dose.

If treatment success is observed before the maximum dose is reached, no further increase of dose is necessary. After clinically relevant improvement of the skin lesions has been achieved, consideration should be given to gradual reduction of the daily dose of dimethyl fumarate to the maintenance dose required by the individual.

Dosage modifications may also be necessary if abnormalities in laboratory parameters are observed.

Dosage considerations

It must be swallowed whole with fluid during or immediately after a meal.

Active ingredient

Dimethyl fumarate

The anti-inflammatory and immunomodulating effects of dimethyl fumarate and its metabolite monomethyl fumarate are not fully elucidated but are thought to be mainly due to the interaction with the intracellular reduced glutathione of cells directly involved in the pathogenesis of psoriasis. Their main activity is considered to be immunomodulatory, resulting in a shift in T helper cells (Th) from the Th1 and Th17 profile to a Th2 phenotype. The mechanism by which dimethyl fumarate exerts therapeutic effects in multiple sclerosis is not fully understood.

Read more about Dimethyl fumarate

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