Elective First-Line Use of Dimethyl Fumarate in Psoriasis: Insights from an Italian Cohort

Alessandro Giunta; Maria Esposito; Elena Campione; Martina  Burlando; Giacomo  Caldarola; Viviana  Lora; Federico  Diotallevi; Ersilia  Tolino; Gianmarco Silvi; Emanuele Cozzani; Ruslana Gaeta Shumak; Rosaria  Fidanza; Paolo  Antonetti; Lorenzo Maria Pinto; Valentina  Mirisola; Maria Concetta Fargnoli; Luca  Bianchi; Francesca Prignano

doi:10.5826/dpc.1504a5458

Elective First-Line Use of Dimethyl Fumarate in Psoriasis: Insights from an Italian Cohort

Authors

Alessandro Giunta Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
Maria Esposito Department of biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Elena Campione Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
Martina Burlando Clinica Dermatologica, DISSAL, Università di Genova, Genova, Italy
Giacomo Caldarola UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
Viviana Lora Division of Dermatology, San Gallicano Dermatological Institute, Rome, Italy
Federico Diotallevi Dermatological Clinic, Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
Ersilia Tolino Unit of Dermatology, Department of Medical-Surgical Science and Biotechnologies, Sapienza University of Rome, A. Fiorini Hospital, Terracina, Latina, Italy
Gianmarco Silvi Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
Emanuele Cozzani Ospedale Policlinico San Martino-IRCCS, Genova, Italy
Ruslana Gaeta Shumak Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
Rosaria Fidanza UOSD Dermatologia Generale ed Oncologica Ospedale San Salvatore L’Aquila ASL1 Abruzzo, L’Aquila, Italy
Paolo Antonetti UOSD Dermatologia Generale ed Oncologica Ospedale San Salvatore L’Aquila ASL1 Abruzzo, L’Aquila, Italy
Lorenzo Maria Pinto UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
Valentina Mirisola Polistudium Srl, Milan, Italy
Maria Concetta Fargnoli Department of biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Luca Bianchi Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
Francesca Prignano Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy

Keywords:

dimethyl fumarate, psoriasis, systemic therapy, long-term treatment

Abstract

Introduction: Dimethyl fumarate (DMF) is an approved conventional systemic treatment for psoriasis that does not exhibit any drug–drug interactions or cumulative organ toxicities.

Aim: This retrospective real-world study aimed to analyze the long-term efficacy, safety, and tolerability of DMF in patients with moderate psoriasis.

Methods: Data on safety and efficacy were collected from medical charts. The effect on disease severity was assessed using the Psoriasis Area Severity Index.

Results: Our study included 148 patients over a 48-week treatment period, confirming DMF as an effective option in the treatment of moderate psoriasis. Adverse events were only mild or moderate, principally flushing, epigastralgia, and diarrhea. However, DMF exhibited a delayed onset of action, and the dropout rate was high. These aspects highlight the importance of educating patients about the activity profile of DMF, the potential occurrence of side effects, and their management. However, side effects are self-limiting with discontinuation of treatment and generally occur early, allowing patients to be promptly switched to other therapies if DMF is not tolerated.

Conclusions: Our results confirm that DMF may be offered as a first-line treatment for moderate psoriasis as it demonstrated efficacy even in the long-term, when treatment is tolerated, especially in patients with a disease duration of less than five years. DMF may also be proposed when the patient presents comorbidities, when immunosuppression is undesired, and/or before the initiation of biological therapies.

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