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 moderate -to-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 clini-cal dermatological practice based on literature data and expert opinion. 20 statements were discussed and voted on using a facil-itator-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 inter-actions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastroin-testinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be mini-mized by dosage adjustments and a slow titration schedule. Hematologic monitoring throughout the treatment course is required to reduce the risk of lymphopenia. This consensus docu-ment provides clinical dermatologists with answers on the optimal use of DMF to treat psoriasis.