Photo: Stethoscope

Dimethyl fumarate (Tecfidera)

Dimethyl fumarate is a treatment for relapsing MS. Its brand name is Tecfidera.

What is Dimethyl fumerate (Tecfidera)?

Dimethyl fumerate, known by the brand name Tecfidera, is a disease modifying treatment (DMT) recommended for the treatment of ‘active’ relapsing multiple sclerosis. This is defined in guidelines as two or more relapses in the last two years.

In one trial, on average, people with multiple sclerosis saw a 53% drop in the number of relapses they had. In another trial, on average, people with MS saw a 38% drop in their disability getting worse. These trial results were compared to people wth MS taking placebos.

Rather than counting a specific number of relapses, increasing numbers of MS specialists define ‘active’ multiple sclerosis as one recent relapse and/or signs on MRI scans that MS is active. These signs include new lesions, areas of damage, in the brain.

How does dimethyl fumarate work to treat MS?

Originally a drug for the treatment of psoriosis, a trial in 2012 found that it could be an effective treatment for multiple sclerosis. 

We don't know exactly how it works, but it dampens down inflammation. This may be helpful in reducing the inflammation that causes damage in the brain and spinal cord of people with MS. In 2014 the National Institute for Health and Care Excellence (NICE) gave the go ahead for the drug to be used on the NHS.

Dimethyl fumarate is a tablet you take twice a day. Taking it with food may help reduce some of its side effects.

How well does dimethyl fumarate work?

MS drugs can be put into three groups based on how well they control it. The effectiveness of dimethyl fumarate is classed as 'good'. This puts it between DMTs classed as 'high' effectiveness and those classed as 'moderate'. This is based on how much it reduces relapses and slows down how fast people's disability gets worse.

Relapses dropped by: 53%

This means that in one trial, on average, people saw a 53% drop in the number of relapses they had. This was compared to people who took a placebo, a dummy treatment with no drug in it.

Disability getting worse was slowed down by: 38%

This means that in one trial, on average, people saw a 38% drop in the risk of their disability getting worse. This was compared to people who took a placebo.

Who is dimethyl fumarate for?

This disease modifing treatment is recommended for those with ‘active’ relapsing multiple sclerosis. Dimethyl fumarate won’t work if you don’t get relapses, so you won’t be offered it if you have primary or secondary progressive MS.

Who can take dimethyl fumarate?

Whether you’ll be offered this drug for relapsing MS depends on if you qualify for it based on guidelines used by your neurologist. These guidelines come from the Association of British Neurologists (ABN) and NICE. 

In Scotland, Wales and Northern Ireland you can have dimethyl fumarate if:

  • you have relapsing MS and you’ve had a recent relapse and/or MRI scans show new signs that your MS is active (you have new lesions)

In England you can have this drug if:

  • you’ve had two relapses in the last two years

Whether you will prescribed a drug also depends on whether the NHS where you live will pay for it.

How can I take dimethyl fumarate (Techfidera)?

Dimethyl fumarate is a tablet you take twice a day. Taking it with food may help reduce some of its side effects.

What are the side effects of dimethyl fumarate?

Compared to other DMTs the risk of side effects, especially serious ones, is somewhere in the middle.

Up to 40% of people have one or more of these: flushing (going red in the face), feeling hot, upset stomach or feeling sick.

You will laso have to have blood tests before and during treatment as it may affect your kidneys and liver and your white blood cell count.

PML: a very rare side effect

Dimethyl fumarate can increase your chances of getting a rare viral brain infection called PML (progressive multifocal leukoencephalopathy). The risk is extremely small but PML can kill or leave a person seriously disabled. As of the end of 2017 only five cases have been seen in over 230,000 people across the world taking dimethyl fumarate.

There's a virus that makes your risk of getting PML higher. Your specialist can tell from a blood test if you have it. If you do, your MS team will talk to you about PML and what you can do about it.