Dimethyl fumarate is the fumaric acid of the methyl ester. It is named after the earth smoke
plant called Fumaria officinalis. Dimethyl fumarate treats various forms of multiple sclerosis,
a disease in which the nerves do not function properly and people may experience
weakness, numbness, loss of muscle coordination, and problems with vision, speech, and
bladder control) among adults. These include clinically isolated syndrome, its nerve
symptom episodes that last at least 24 hours, for relapsing-remitting forms or secondary
progressive forms. Dimethyl fumarate is an Nrf2 activator, whose actions decrease
inflammation and prevent nerve damage caused by multiple sclerosis. It has great
immunomodulatory properties while not suppressing the immune in adults.
DMF is sold for psoriasis treatment and sold as an oral formulation mixed with related
compounds in Germany. In the UK, it is sold as a pure oral formulation. It is sold in the U.S.
as an oral formulation to treat adults with relapsing multiple sclerosis.
Dimethyl fumarate is sold under the brand name Skilarence & Tecfidera, just to name a few.
Walter Schweckendiek, a German chemist first used fumaric acid, as a topical formulation
for psoriasis in 1959. Fumapharm, The Swiss company, brought Fumaderm, an oral
formulation of Dimethyl fumarate in Germany in 1994 to treat psoriasis.
Dosage and administration
Dimethyl fumarate is sold as 30 mg and 120 mg tablets.
In the treatment of multiple sclerosis, the standard adult doses are 120 mg and 240 mg, with
the maximum daily dose limited to 480 mg. The user is given a starting dose of 120 mg twice
a day, orally. After a week, they are given a maintenance dose of 240 mg twice a day, orally.
Reductions in dose are considered for individuals who do not tolerate the maintenance dose,
however, the dosage should resume within 4 weeks. If users are unable to tolerate a return
to the maintenance, the treatment is discontinued.
The cost of Dimethyl fumarate
In the UK, the annual cost of treatment on Dimethyl fumarate is £17,900 year. In the USA,
the consumer has to pay an average retail price of $11,646.72 for a course of annual
treatment.
How does Dimethyl fumarate work?
Dimethyl fumarate's main action is immunomodulation. This results in shifting T helper cells
from the Th1 and Th17 profile to a Th2 phenotype. Dimethyl fumarates reduce the
production of Inflammatory cytokines by inducting proapoptotic events. It also inhibits
keratinocyte proliferation, reduces the expression of adhesion molecules in addition to
diminishing the inflammatory infiltrate within psoriatic plaques. It is also shown to reduce the
expression of micro-RNA-2. This is essential for producing pathogenic cells in multiple
sclerosis and psoriasis. DMF achieves this through cell-permeable metabolites that
epigenetically regulate the expression of micro-RNA-21, which it does through metabolic-
epigenetic interplay during the development of immune cells in the body.
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