Burlando Martina, Campione Elena, Cuccia Aldo, Malara Giovanna, Naldi Luigi, Prignano Francesca, Zichichi Leonardo
Dermatology Unit, IRCCS San Martino University Hospital, Genoa.
Dermatology Unit, University of Rome Tor Vergata.
Dermatol Reports. 2022 Dec 29;15(2):9613. doi: 10.4081/dr.2023.9613. eCollection 2023 Jun 7.
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.
富马酸二甲酯（DMF）最近被欧洲药品管理局批准用于中重度慢性斑块状银屑病的全身治疗。需要对DMF治疗进行适当管理以实现最佳临床效益。7名皮肤科专家在线召开了3次会议，就DMF在患者选择、药物剂量/滴定、副作用管理和随访方面的使用达成共识，旨在根据文献数据和专家意见为临床皮肤科实践中使用DMF治疗银屑病提供指导。使用主持人介导的改良德尔菲方法对20条陈述进行了讨论和投票。所有陈述均达成了强烈共识（一致同意率为100%）。DMF治疗的特点是剂量灵活性高、疗效持续、药物留存率高且药物相互作用可能性低。它可用于广泛的患者，包括老年人或患有合并症的患者。副作用（主要是胃肠道疾病、潮红和淋巴细胞减少）经常被报告，但通常较轻且短暂，可通过调整剂量和缓慢滴定方案将其降至最低。在整个治疗过程中需要进行血液学监测以降低淋巴细胞减少的风险。本共识文件为临床皮肤科医生提供了关于DMF治疗银屑病最佳用法的答案。
