title: Long-term safety and effectiveness of high-dose dimethylfumarate in the treatment of moderate to severe psoriasis: a prospective single-blinded follow-up study.
abstract: BACKGROUND
  Mixtures of fumaric acid esters (FAE) are used as an oral systemic treatment for moderate to severe psoriasis. Large clinical studies with dimethylfumarate (DMF) monotherapy are scarce.
  
  
  OBJECTIVE
  The objective of this study is to assess the effectiveness and long-term safety of high-dose DMF monotherapy in moderate to severe psoriasis.
  
  
  METHODS
  A prospective single-blinded follow-up study was performed in a cohort of patients treated with DMF. Patients were followed-up at fixed intervals. Assessment of consecutive photographs was performed by two observers. Primary outcome was a change in static physician global assessment (PGA) score. Safety outcome was defined as incidences of (serious) adverse events.
  
  
  RESULTS
  A total of 176 patients with moderate to severe psoriasis were treated with DMF for a median duration of 28 months. The median daily maintenance dosage of 480 mg was reached after a median of 8 months. Psoriasis activity decreased significantly by 1.7 out of five points. A total of 152 patients reported one or more adverse events, such as gastrointestinal complaints and flushing.
  
  
  CONCLUSIONS
  High-dose DMF monotherapy is an effective and safe treatment option in moderate to severe psoriasis. It can be suggested that 50% of all patients may benefit from high-dose DMF monotherapy.
authors.affiliation: a Department of Dermatology , Laurentius Hospital , Roermond , The Netherlands .
authors.forename: Raphaël
authors.initials: R
authors.lastname: Lijnen
authors.affiliation: b Department of Dermatology , Radboud University Medical Center , The Netherlands , and.
authors.forename: Elsemieke
authors.initials: E
authors.lastname: Otters
authors.affiliation: c Department of Dermatology , Erasmus Medical Centre , Rotterdam , The Netherlands.
authors.forename: Deepak
authors.initials: D
authors.lastname: Balak
authors.affiliation: c Department of Dermatology , Erasmus Medical Centre , Rotterdam , The Netherlands.
authors.forename: Bing
authors.initials: B
authors.lastname: Thio
mesh_terms: D000284:Administration, Oral; D000328:Adult; D003879:Dermatologic Agents / Q000627:therapeutic use*; D000069462:Dimethyl Fumarate / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy*; D016037:Single-Blind Method
chemical_list: D003879:Dermatologic Agents; D000069462:Dimethyl Fumarate
keywords: Dimethylfumurate; high dose; monotherapy; prospective study; psoriasis