Diroximel fumarate (Vumerity)

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• Who can take diroximel fumarate (Vumerity)?
• How does diroximel fumarate (Vumerity) work?
• How well does diroximel fumarate (Vumerity) work?
• Diroximel fumarate (Vumerity) side effects
• Stopping diroximel fumarate (Vumerity)
• What tests do you need with diroximel fumarate (Vumerity)?
• Diroximel fumarate (Vumerity) and pregnancy, breastfeeding and contraception

Who can take diroximel fumarate (Vumerity)?

Diroximel fumarate (Vumerity) is recommended for people with ‘active’ relapsing MS. That means you’ve had a recent relapse, or MRI scans show new, active or growing lesions (areas of damage) in your brain or spinal cord.  

You’ll be given diroximel fumarate (Vumerity) if you had problems with side effects when taking dimethyl fumarate (Tecfidera). They are very similar drugs but, in clinical trials, people taking diroximel fumarate (Vumerity) had fewer side effects.

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How does diroximel fumarate (Vumerity) work?

We don’t know exactly how diroximel fumarate (Vumerity) 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. 

This drug works very much like a DMT that’s been available in the UK since 2014 called dimethyl fumarate (Tecfidera).

Diroximel fumarate is a tablet you take twice a day.

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How well does diroximel fumarate (Vumerity) work?

The effectiveness of diroximel fumarate (Vumerity) is classed as ‘good’. Each DMT can be rated as ‘moderate’, ‘good’ or ‘high’. This is based on how much it can reduce relapses and slow down disability getting worse.

Once it’s in the body, diroximel fumarate (Vumerity) becomes just like dimethyl fumarate (Tecfidera) so it acts in the same way. Because of this, to explain how well diroximel fumarate works, neurologists use results from trials on dimethyl fumarate (Tecfidera). When dimethyl fumarate (Tecfidera) was studied: 

Relapses dropped by 53% compared to placebo

In the two-year DEFINE 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 by 38% compared to placebo

In the DEFINE 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.

A second two-year trial of dimethyl fumarate (Tecfidera), called CONFIRM, had similar results.

There have been two studies on diroximel fumarate (Vumerity) itself. The EVOLVE-MS-1 and EVOLVE-MS-2 trials mostly looked at the drug’s side effects.

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Diroximel fumarate (Vumerity) side effects

Very common side effects (more than 1 in 10 people get them):

• flushing (going red in the face)
• feeling hot
• upset stomach
• feeling sick

Common side effects (up to 1 in 10 people get them):

• being sick
• indigestion
• itchy skin
• rash
• hair loss
• a drop in white blood cells (lymphopenia)

Side effects usually get better after a few weeks. Talk to your MS team about ways you can manage side effects. Medicines you can buy over the counter may help, like antacids or anti-diarrhoea medicines.

Flushing and stomach problems are the most common side effects. Taking diroximel fumarate (Vumerity) just after food may help. Talk to your MS team about whether taking an aspirin before you take the drug might help with flushing. 

Find out more about all the possible side effects of diroximel fumarate (Vumerity)

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Stopping diroximel fumarate (Vumerity)

You should never stop taking a DMT without telling your neurologist. With some DMTs, if you suddenly stop, there’s a risk of ‘rebound’. This is when your MS gets much worse within a few weeks or months. 

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What tests do you need with diroximel fumarate (Vumerity)?

Diroximel fumarate may affect your kidneys and liver and how many white blood cells you have. So you’ll have blood tests before treatment and every three months during it to check for this. You may also have tests on your pee before and during treatment.

Like most DMTs, this drug makes infections more likely. Before you start it, your neurologist will check if you have protection against some of the infections it puts you at risk of. 

Your neurologist will check you’re up to date on your vaccines. This includes childhood ones like chickenpox (that vaccine protects you against shingles) and the MMR vaccine for measles, mumps and rubella. Some ‘live’ vaccines, like these two, aren’t safe to have once you’ve started many DMTs. Your MS team or GP can tell you whether a vaccine is ‘live’ or not. 

You’ll have any vaccines you need a few weeks before you start this drug. 

You can safely have the annual flu jab while taking this DMT. 

Read more about vaccines

Your neurologist might want you to have an MRI scan once a year to see if the drug is working. But how often you have scans depends on what your neurologist thinks you need. If your MS seems stable, you might have scans less often.

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Diroximel fumarate (Vumerity) and pregnancy, breastfeeding and contraception

Pregnancy

Diroximel fumarate (Vumerity) isn’t licensed to be used during pregnancy. In animal studies it harmed the unborn. We need more studies into whether it can do this with people, although some studies have found it was safe in pregnancy.

Guidelines say it’s best to avoid getting pregnant while taking this drug. If you think you’re pregnant, get medical advice at once about coming off the drug.

Your neurologist may recommend that you keep taking it through your pregnancy if the benefits of doing so outweigh the risks. If you can get pregnant, talk to your neurologist. You can talk about the benefits and risks of taking diroximel fumarate while pregnant, and whether to switch to a different DMT.

There’s no set time for the ‘washout period’ for this drug. This is how long it takes for the drug to leave your body.

If you want to have a child, discuss this with your neurologist or MS nurse. If you think you’ve become pregnant, let your medical team know at once. Never stop your DMT without first getting their advice.

Breastfeeding

It’s not clear if enough diroximel fumarate (Vumerity) gets into breast milk to be a risk. Ask your medical team for advice.

Contraception

If you can get pregnant, you should use reliable contraception while taking this drug (like ‘the pill’, condoms, a coil, injections or implant).

Read more about pregnancy, breastfeeding and contraception and DMTs

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