title: Efficacy and safety of oral fumarate in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, double-blind, placebo-controlled phase IIb study.
abstract: BACKGROUND
  Oral fumarate (BG00012) might have dual anti-inflammatory and neuroprotective effects. Our aim was to assess the efficacy and safety of BG00012 in patients with relapsing-remitting multiple sclerosis.
  
  
  METHODS
  257 patients, aged 18-55 years, with relapsing-remitting multiple sclerosis were randomly assigned to receive 120 mg once daily (n=64), 120 mg three times daily (n=64), or 240 mg three times daily (n=64) BG00012, or placebo (n=65) for 24 weeks. During an extension period of 24 weeks for safety assessment, patients treated with placebo received BG00012 240 mg three times daily. The primary endpoint was total number of new gadolinium enhancing (GdE) lesions on brain MRI scans at weeks 12, 16, 20, and 24. Additional endpoints included cumulative number of new GdE lesions (weeks 4-24), new or enlarging T2-hyperintense lesions, new T1-hypointense lesions at week 24, and annualised relapse rate. Analysis was done on the efficacy-evaluable population. Safety and tolerability were also assessed. This study is registered with ClinicalTrials.gov, number NCT00168701.
  
  
  RESULTS
  Treatment with BG00012 240 mg three times daily reduced by 69% the mean total number of new GdE lesions from week 12 to 24 compared with placebo (1.4 vs 4.5, p<0.0001). It also reduced number of new or enlarging T2-hyperintense (p=0.0006) and new T1-hypointense (p=0.014) lesions compared with placebo. BG00012 reduced annualised relapse rate by 32% (0.44 vs 0.65 for placebo; p=0.272). Adverse events more common in patients given BG00012 than in those given placebo included abdominal pain, flushing, and hot flush. Dose-related adverse events in patients on BG00012 were headache, fatigue, and feeling hot.
  
  
  CONCLUSIONS
  The anti-inflammatory effects and favourable safety profile of BG00012 warrant further long-term phase III studies in large patient groups.
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.forename: David H
authors.initials: DH
authors.lastname: Miller
authors.forename: David G
authors.initials: DG
authors.lastname: Macmanus
authors.forename: Eva
authors.initials: E
authors.lastname: Havrdova
authors.forename: Volker
authors.initials: V
authors.lastname: Limmroth
authors.forename: Chris H
authors.initials: CH
authors.lastname: Polman
authors.forename: Klaus
authors.initials: K
authors.lastname: Schmierer
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Yousry
authors.forename: Minhua
authors.initials: M
authors.lastname: Yang
authors.forename: Mefkûre
authors.initials: M
authors.lastname: Eraksoy
authors.forename: Eva
authors.initials: E
authors.lastname: Meluzinova
authors.forename: Ivan
authors.initials: I
authors.lastname: Rektor
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Dawson
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Sandrock
authors.forename: Gilmore N
authors.initials: GN
authors.lastname: O'Neill
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000069462:Dimethyl Fumarate; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005650:Fumarates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D010352:Patient Dropouts
chemical_list: D005650:Fumarates; D007166:Immunosuppressive Agents; D000069462:Dimethyl Fumarate