Real-world use of dimethyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus.

Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderateto- severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. 7 dermatology experts gathered online for 3 meetings to identify consensus on the use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on the use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. 20 statements were discussed and voted on using a facilitator- mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug-drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and a slow titration schedule. Hematologic monitoring throughout the treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on the optimal use of DMF to treat psoriasis.

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Conflict of interest: MB, served as a consultant and received fees and speaker's honoraria from AbbVie, Almirall, Amgen, Eli Lilly, Janssen, Leo Pharma, Novartis, and UCB. EC, served as a consultant for Almirall, BMS, Amgen, and UCB; GM, reports no conflict of interest. AC, has been an advisor board member and/or consultant and/or received speakers’ honoraria and/or received grants and/or received research support and/or participated in clinical trials with the following pharmaceutical companies: Almirall, Amgen, Eli Lilly, Janssen- Cilag, Novartis; LN, has received honoraria as a scientific consultant for AbbVie, Almirall, Boehringer Ingelheim, Bristol Myers Squibb, IBSA, Janssen, Leo, Lilly, Novartis, Pfizer, and Sanofi; FP, served as advisory board member and consultant and received fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Biogen, Boehringer-Ingelheim, Leo Pharma, Lilly, Janssen, Novartis, and Sanofi Genzyme; LZ, received honoraria as a scientific consultant for AbbVie, Almirall, Leo, Lilly, and Novartis. Informed consent: the manuscript does not contain any individual person’s data in any form.