Author Topic: (AAN) Transient neurologic worsening after starting Tecfidera in progressive MS  (Read 223 times)

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Offline agate

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Presented as a poster session at the AAN annual conference in Philadelphia, April 29, 2014:

[P2.228] Transient Neurologic Worsening after Initiation of Dimethyl Fumarate Therapy in Progressive Multiple Sclerosis Patients

James Stark, Sydney Chirls, Saud Sadiq

New York, NY, USA


To describe a syndrome of neurologic worsening after initiation of dimethyl fumarate in patients with progressive forms of MS.


Dimethyl fumarate (DMF) was recently approved for the treatment of relapsing forms of multiple sclerosis. Given its novel mechanism of action, there has been considerable interest in the study of DMF in patients with progressive forms of MS, as treatment options are limited. We used DMF for progressive MS as an off label agent.


This is a retrospective chart review at a single MS center of patients who initiated treatment with DMF. All patients gave an informed consent and the study is IRB approved.


All progressive disease MS patients at our center who were not on other disease modifying therapy and consented to take DMF were included in the analysis. We identified 14 of 259 (5%)patients who following initiation of DMF treatment developed acute neurologic worsening. Ten of the 14 patients had secondary progressive MS and 4 had primary progressive. Eleven of the 14 patients (78%) were female with a mean age of 52 years (range 41-61), and patients had a mean disease duration of 19.7 years (range 10-30). The EDSS ranged from 3.5 to 8.5 (mean 6.3). The duration of DMF treatment before the onset of worsening neurologic symptoms was variable (1-42 days). The most common neurologic complaint was increased motor weakness.

All patients returned to baseline neurologic status after discontinuation of DMF, generally within a few days.


Patients with progressive forms of MS may experience a transient worsening of neurologic function following initiation of therapy with DMF. This effect appears independent of the subtype of progressive disease and not related to the well described adverse effects associated with DMF therapy. It is likely that this worsening is caused by a conduction block as it reverses with cessation of treatment.

Study Supported by:

Category - MS and CNS Inflammatory Disease: Clinical Science

P2: Poster Session II: MS and CNS Inflammatory Disease: Treatment Safety
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SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.