Dimethyl fumarate is recommended by NICE as an option for treating severe plaque psoriasis in adults who have not responded to other systemic therapies, including ciclosporin, methotrexate and PUVA, or if these options are contraindicated or not tolerated.
Severe psoriasis is defined by NICE as a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10.
NICE considered that dimethyl fumarate improves severe psoriasis more than placebo but, when compared indirectly, it is less effective than systemic biological therapies and apremilast.
However, the cost-effectiveness of dimethyl fumarate followed by best supportive care compared with best supportive care alone was deemed to be comparable with previous cost-effectiveness estimates of the biologicals and apremilast.
Also, as dimethyl fumarate is less costly than biologicals and apremilast, NICE concluded that it would probably provide sufficient savings per quality-adjusted life year lost compared with these treatments.
Prescribers should stop dimethyl fumarate at 16 weeks if the patient's response is not adequate. An adequate response is defined as a 75% reduction in the PASI score (PASI 75) or a 50% reduction in the PASI score plus a 5-point reduction in DLQI.