MS- Dimethyl Fumarate DI

Question 1

Dimethyl fumarate brand name

Answer 1

Tecfidera

Question 2

Dimethyl fumarate indications

Answer 2

Relapsing forms of MS (CIS, RRMS, active SPMS)

Question 3

MoA of dimethyl fumarate

Answer 3

Induces T-helper 2-like cytokines –> apoptosis in activated T-cells, downregulation of intracellular adhesion molecules –> reduced migration of lymphocytes

Question 4

Dimethyl fumarate dosing

Answer 4

120mg PO BID x7 days, then 240mg PO BID

Question 5

What should you do about the dimethyl fumarate tablets?

Answer 5

DO NOT CRUSH

Question 6

Dimethyl fumarate side effects

Answer 6

GI symptoms (diarrhea, cramping, nausea), flushing, transient increases in LFTs, transient eosinophilia, lymphopenia, PML

Question 7

Management of GI symptoms from dimethyl fumarate

Answer 7

Take it with or without food, but if it is with food, try it with a high protein and high fat meal

Question 8

Management of flushing from dimethyl fumarate

Answer 8

Take nonenteric coated ASA 30 mins prior to dose or decrease the dose to 120mg BID with the intent of returning to the 240mg BID dose

Question 9

Dimethyl fumarate monitoring

Answer 9

LFTs, recent CBC, MRI, urinalysis, signs/symptoms of hypersensitivity, infections, and PML