title: Consensus Management of Gastrointestinal Events Associated with Delayed-Release Dimethyl Fumarate: A Delphi Study.
abstract: BACKGROUND
  Delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF) is indicated for the treatment of patients with relapsing multiple sclerosis. Gastrointestinal (GI) adverse events (AEs) occur with DMF therapy.
  
  
  METHODS
  We used a Delphi process to reach consensus among North American clinicians on effective real-world management strategies for GI AEs associated with DMF. Clinicians were asked to complete two rounds of questionnaires developed by a steering committee; consensus in round 2 was attained if ≥70% of respondents agreed on a particular strategy.
  
  
  RESULTS
  Consensus was reached on several strategies to manage GI AEs, including administering DMF with food, slow titration, dose reduction, and use of symptomatic therapies.
  
  
  CONCLUSIONS
  These consensus strategies provide clinicians with information on real-world approaches used to address the tolerability of DMF in patients with multiple sclerosis.
  
  
  BACKGROUND
  Biogen.
authors.affiliation: Baylor Institute for Immunology Research, Dallas, TX, USA. j.theod.phillips@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Theodore Phillips
authors.affiliation: NeuroMedical Center Clinic, Baton Rouge, LA, USA.
authors.forename: April A
authors.initials: AA
authors.lastname: Erwin
authors.affiliation: Multiple Sclerosis Clinic of Central Texas, Round Rock, TX, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Agrella
authors.affiliation: Western University and London Health Sciences Centre, London, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Kremenchutzky
authors.affiliation: Center For Neurological Disorders, S.C., Milwaukee, WI, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Kramer
authors.affiliation: Excel Scientific Solutions, Horsham, UK.
authors.forename: Malcolm J M
authors.initials: MJ
authors.lastname: Darkes
authors.affiliation: Biogen, Weston, MA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kendter
authors.affiliation: Biogen, Cambridge, MA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Abourjaily
authors.affiliation: Biogen, Cambridge, MA, USA.
authors.forename: Jitesh
authors.initials: J
authors.lastname: Rana
authors.affiliation: Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fox
keywords: Delayed-release dimethyl fumarate; Delphi technique; Disease management; Health care surveys; Multiple sclerosis