title: Fumarate treatment in progressive forms of multiple sclerosis: first results of a single-center observational study.
abstract: OBJECTIVE
  Therapeutic options in progressive forms of multiple sclerosis (MS) are still limited. Dimethyl fumarate (DMF) has immunomodulatory properties but may also exert antioxidative cytoprotective effects. Hence, it may be a therapeutic option for progressive MS. The aim of this observational study was to evaluate safety, adherence and efficacy of fumarates in patients with primary progressive MS (PPMS) or secondary progressive MS.
  
  
  METHODS
  Patients with progressive MS whose condition had failed to respond to standard therapies and had worsened received the fumarate mixture Fumaderm, licensed for psoriasis therapy in Germany, or DMF by pharmaceutical preparation (Bochum ethics approval no. 4797-13). At regular follow-up visits, tolerability and disease course were assessed.
  
  
  RESULTS
  Twenty-six patients [age 54 ± 7.8 years; female = 13 (50%); PPMS = 12 (46.2%); Expanded Disability Status Scale (EDSS) = 6.0 ± 0.4 (range 3.5-8.0); disease duration = 14.1 ± 8.7 years] were initiated on treatment with Fumaderm (n = 18) or pharmacy-prepared DMF (n=8). During a mean follow-up period of 13.2 ± 7.5 months (range 6-30) only five patients (19.2%) reported minor complaints. In 15 patients (57.7%) EDSS remained stable. In five cases (19.2%) there was even a decrease in EDSS while in six patients (23.1%) there was an increase in EDSS of more than 0.5 points, reflecting deterioration. Laboratory values were controlled for lymphopenia, renal and hepatic values, without any safety problems. We observed no significant differences between the two pharmaceutical forms.
  
  
  CONCLUSIONS
  Our pilot data indicate that fumarate therapy appears to be safe and well tolerated by patients with progressive MS. In more than 75% of cases no further disease progression was evident. However, controlled studies are warranted to evaluate the detailed therapeutic potential of fumarates and their long-term effects in progressive MS.
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Bochum, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Strassburger-Krogias
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Bochum, Germany.
authors.forename: Gisa
authors.initials: G
authors.lastname: Ellrichmann
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Bochum, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
authors.affiliation: Department of Dermatology, Ruhr University Bochum, St Josef-Hospital, Bochum, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Bochum, Germany.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Gudrunstraße 56, 44791 Bochum, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
keywords: antioxidative; cytoprotective; fumarate; neurodegeneration; progressive multiple sclerosis