Dimethyl Fumarate Not Associated With Greater Pain vs Other DMTs in Relapsing-Remitting MS

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Higher pain scores were reported by patients taking interferons compared with other DMTs.
Higher pain scores were reported by patients taking interferons compared with other DMTs.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2018.

A study presented at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2 in Nashville, Tennessee, suggests that interferons are associated with greater pain risk than other disease-modifying therapies (DMTs) in patients with relapsing-remitting multiple sclerosis (MS).

“Although pain is a common manifestation in patients with [MS], previous clinical studies have not explored the possible pharmacologic effect of [DMT] in pain management,” according to the investigators. “Dimethyl fumarate (DMF) is an oral DMT approved by the US Food and Drug Administration for treatment of MS ... recent animal studies suggest that the active metabolite of DMF can inhibit pain behaviors through an inhibition of reactive oxygen species production that involves the central nucleus of amygdala. Therefore, there is a possibility that pain may be less frequent in MS patients receiving DMF.”

Patients with relapsing-remitting MS treated at the MS Neurology Clinic at Texas Tech University Health Sciences Center (n=96) were recruited to determine if DMF was associated with more pain than other DMTs. A 0 to 10 numeric rating scale as well as the Short-Form McGill Pain Questionnaire were used to assess pain outcomes. The investigators also examined electronic medical records and current and past DMT use.

In the cohort, there was no significant difference between those in the DMF group and the other-DMT group in terms of the duration of disease (7.0 years vs 8.2 years, respectively; P =.41). Additionally, there was no significant difference between the DMF and other-DMT group in relation to the proportion of patients who were currently being treated with pain medication (60.0% vs 43.4%, respectively; P =.19). No differences were reported between the 2 groups for pain intensity (4.8 vs 4.8; P =.99) or the Short-Form McGill Pain Questionnaire score (5.9 [DMF] vs 5.4 [other-DMT]; P =.54).

A total of 39 patients (40.6%) had severe pain at their follow-up visit, as represented by a McGill Pain Questionnaire score ≥7. Approximately 50.0% of patients who were taking DMF reported severe pain (n = 10). Patients taking interferons reported higher pain rates compared with other DMTs, with Avonex® being the most frequently used medication among these patients (83.3%). The investigators found no difference between other oral medications and DMF in terms of pain (P =.14).

“Besides having an anti-inflammatory effect from modulating immune responses, DMF also has the distinct antioxidant effect through the nuclear factor erythroid-2 related factor-2 (Nrf2)-dependent antioxidant response element pathway,” the investigators explained. “Further prospective studies with a larger population are necessary for evaluating the association between pain and DMF.”

For more coverage of CMSC 2018, click here.

Reference

Karukote A, Neugebauer V, Avila M. Pain in multiple sclerosis: is dimethyl fumarate associated with less pain when compared to other disease-modifying therapies? Presented at: 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers. May 30-June 2, 2018; Nashville, TN. Abstract DX29.

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