The Effectiveness of Dimethyl Fumarate Monotherapy in the Treatment of Relapsing-Remitting Multiple Sclerosis: A Systematic Review and Meta-Analysis
Pawel Kawalec, Alicja Mikrut, Natalia Wisniewska and Andrzej Pilc
Affiliation: Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka St, 31-531 Krakow, Poland.
Background: Dimethyl fumarate (BG-12, Tecfidera®) is a new oral drug approved by FDA and EMA in March
2013 for relapsing – remitting multiple sclerosis (RRMS). The drug was much anticipated because of its possible
superiority over currently available medications: fingolimod and teriflunomide as the only MS treatments currently
available in oral form.
Objective: The aim of this systematic review with meta-analysis was to assess the efficacy and safety of BG-12 in the
treatment of RRMS.
Methods: A systematic literature search was conducted in Medline/PubMed, EMBASE, and Cochrane Library up till 3rd
November, 2013. We sought all published randomized clinical trials evaluating the use of dimethyl fumarate for the
treatment of patients with RRMS. All included studies were critically appraised and analyzed with the use of Review
Manager 5.1.0. software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement protocol.
Results: Two trials, DEFINE and CONFIRM involved 2 651 patients and compared dimethyl fumarate taken either two or
three times daily with placebo in patients with RRMS. Additionally in CONFIRM trial third group of patients received
glatiramer acetate. The overall results of the meta-analysis showed that BG-12 (at both dosages) given to patients with
RRMS is safe and statistically significantly more effective than placebo in reducing the proportion of patients who had
a relapse by 2 years, the rate of disability progression and the mean number of gadolinium-enhancing lesions at 2 years.
The comparison between BG-12 and glatiramer acetate revealed that the analyzed agent could potentially be more
effective in the treatment of RRMS.
Conclusions: Despite limited RCTs data available, both analyzed BG-12 regimens showed their efficacy on clinical
disease parameters and other measures of disease activity in RRMS. The safety profile of the study agent was acceptable.
Keywords: Autoimmune disorder, dimethyl fumarate, disease-modifying therapies, relapsing-remitting multiple sclerosis.
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