Multiple sclerosis: Do not discontinue dimethyl fumarate despite death

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MunichA patient suffering from multiple sclerosis died of the side effects of a drug. She had received the active ingredient dimethyl fumarate as part of a study. The drug had weakened her immune system, and a viral infection was fatal. However, experts warn against jumping to conclusions.

"This regrettable death must not lead to patients now stopping the drug as a short-circuit reaction," warns Prof. Ralf Gold from the German Society for Neurology (DGN). Rather, the case shows that a blood count check every six to eight weeks is indispensable for treatment with dimethyl fumarate - just like with other drugs used to treat MS. In particular, the cell counts for leukocytes and lymphocytes should be determined.

Benefit undisputed

Together with the Disease-Related Competence Network Multiple Sclerosis (KKNMS), the experts from the DGN are calling for significantly closer monitoring than specified by the manufacturer. These only indicate the need for a six-monthly blood test.

The closer inspection could make it easier to detect serious side effects.Fundamental doubts about the active ingredient have not been raised, and its benefits for patients are undisputed, according to Gold. However, the expert admits, "greater attention must be paid to a viral infection as a possible serious complication".

Effect favors infections

Dimethyl fumarate has long been used in the treatment of psoriasis. It has been approved for basic MS therapy in Germany since the beginning of 2014. It can be used orally and is said to reduce the frequency of relapses and slow the progression of the disease. Known side effects are indigestion, hot flashes and diarrhea. Since the effect of dimethyl fumarate is based primarily on its immunomodulating and anti-inflammatory properties, the active ingredient can promote infections.

This is exactly what happened to a German MS patient who had been taking dimethyl fumarate for four and a half years as part of a study. In the process, she developed a severe and persistent lack of lymphocytes. She died of pneumonia. (lh)

Source: Press release German Society for Neurology: Dimethyl fumarate; Access: October 27, 2014

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