Dimethyl fumarate in the treatment of multiple sclerosis: real-world effectiveness in a Turkish cohort

Background Dimethyl fumarate (DMF) is approved as a first-line treatment in relapsing-remitting multiple sclerosis (RRMS). Aim To evaluate the demographic, clinical, and radiological outcomes of DMF treatment in a real-world setting. Study design Multicenter retrospective study based on data from 61 clinics across Türkiye. Methods Side effects, leukocyte and lymphocyte counts, liver enzymes, EDSS (Expanded Disability Status Scale), and upper- and lower-extremity test results were evaluated in patients with RRMS before DMF initiation and at 1, 6, 12, and 24 months. Additionally, NEDA-3 (No Evidence of Disease Activity-3) status was assessed at the 1 and 2-year follow-ups. Results 1,749 patients participated in this retrospective study. The most common side effects were flushing and gastrointestinal symptoms, which were more frequent in women and in patients with lower weight and lower Body Mass Index (BMI). Leukocyte and lymphocyte counts initially decreased and then stabilized, whereas transient elevations in liver enzymes resolved during follow-up. EDSS scores showed a significant improvement beginning at the 6-month follow-up. Performance on the Nine-Hole Peg Test (9HPT) improved, whereas no significant change was observed in the Timed 25-Foot Walk (T25FW). In addition, approximately 70% of the patients achieved NEDA-3 status at both the 1 and 2-year follow-ups. Conclusion DMF demonstrated a favorable safety profile and was associated with significant improvements in EDSS while maintaining NEDA-3 status in approximately 70% of patients with RRMS. Adverse events occurred more frequently among women and among patients with lower body weight and lower BMI.

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Journal
Frontiers in Neurology
Published
2026-11-03
DOI
https://doi.org/10.3389/fneur.2026.1920500
Primary Topic
Multiple Sclerosis Research Studies
Type
article
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article

Dimethyl fumarate in the treatment of multiple sclerosis: real-world effectiveness in a Turkish cohort

Belgin Koçer, Vildan Güzel, Aslı Tuncer, Aydan Köysüren et al.
Frontiers in Neurology
Multiple Sclerosis Research Studies
article

Dimethyl fumarate in the treatment of multiple sclerosis: real-world effectiveness in a Turkish cohort

Belgin Koçer, Vildan Güzel, Aslı Tuncer, Aydan Köysüren, Abdülkadir Tunç, Bedirhan Mengüç, Ahmet Özşimşek, Gökhan Arslan, Aylin Akçalı, Bülent Güven, Saltanat Mert, Bilgin Öztürk, Nurhan Kaya Tutar, Şule Aydın Türkoğlu, Özlem Ethemoğlu, Melike Batum, İlknur Aydın Cantürk, Ömer Faruk Turan, Dilcan Kotan, Dürdane Aksoy, Nur Yüceyar, Yaşar Altun, Mehmet Tecellioğlu, Ahmet Kasım Kiliç, Fatma Avşar Ertürk, Meryem Tuba Sönmez, Adalet Arıkanoğlu, Fatma Akkoyun Arıkan, Caner Baydar, Cavit Boz, Yeşim Eylev Akboğa, Vedat Çilingir, Hatice Mavioğlu, Serkan Özben, Sibel Canbaz Kabay, Murat Alpua, Şeyda FİGÜL GÖKÇE, Ersin Kasım Ulusoy, İrem Taşçı, Mehmet Uğur Çevik, Emine Rabia Koç, Hüsnü Efendi, Levent Öcek, Ahmet Yabalak, Gülgün Uncu, Bedriye Karaman, Cihat Uzunköprü, Sena Destan Bünül, Fettah Eren, Ali Özhan Sıvacı, Huriye Hayat Güven, Sedat Şen, Gülin Sunter, Rana Karabudak, Nuray Bilge, Furkan Sarıdaş, Yesim Yetimalar Beckmann, Neslihan Eşkut, Mehmet Fatih Yetkin, Aytül Mutlu, Burcu Altunrende, İbrahim Acır, Elif Merve Helvacı, Aslı Aksoy Gündoğdu, Vildan Yayla, Gençer Genç, Serpil Demirci, Meral Seferoğlu, Azize Esra Gürsoy, Caner Feyzi Demir, Serpil Bulut, Yılmaz İnanç, Esra Derya Dinç Polat, Ayşen Onder, Belgin Petek Balcı, Feti Cetin, Ferah Kızılay, Nilda Turgut, Sami Ömerhoca, Funda Tan, Zeynep Ozdemir, Aysu Cetiner Seker, PINAR ÖZTÜRK, TAHİR KURTULUŞ YOLDAŞ, GÜLNUR TEKGÖL UZUNER, Recai Türkoǧlu, Nilüfer Kale İçen, Fatma Kurtuluş Aydın, Asli Köşderelioǧlu, Nazire Pınar Acar Özer, Rabia Gökçen Gözübatik Çelik, Duygu Arslan Mehdiyev, Mehmet İlker Yön, Zeynep Özözen Ayas, Dilek Günal, Münire Kilinç, Rumeysa Hilal Kaşkçı, Semra Mungan, Mustafa Açikgöz, Kadriye Aǧan
article en

Abstract

Background Dimethyl fumarate (DMF) is approved as a first-line treatment in relapsing-remitting multiple sclerosis (RRMS). Aim To evaluate the demographic, clinical, and radiological outcomes of DMF treatment in a real-world setting. Study design Multicenter retrospective study based on data from 61 clinics across Türkiye. Methods Side effects, leukocyte and lymphocyte counts, liver enzymes, EDSS (Expanded Disability Status Scale), and upper- and lower-extremity test results were evaluated in patients with RRMS before DMF initiation and at 1, 6, 12, and 24 months. Additionally, NEDA-3 (No Evidence of Disease Activity-3) status was assessed at the 1 and 2-year follow-ups. Results 1,749 patients participated in this retrospective study. The most common side effects were flushing and gastrointestinal symptoms, which were more frequent in women and in patients with lower weight and lower Body Mass Index (BMI). Leukocyte and lymphocyte counts initially decreased and then stabilized, whereas transient elevations in liver enzymes resolved during follow-up. EDSS scores showed a significant improvement beginning at the 6-month follow-up. Performance on the Nine-Hole Peg Test (9HPT) improved, whereas no significant change was observed in the Timed 25-Foot Walk (T25FW). In addition, approximately 70% of the patients achieved NEDA-3 status at both the 1 and 2-year follow-ups. Conclusion DMF demonstrated a favorable safety profile and was associated with significant improvements in EDSS while maintaining NEDA-3 status in approximately 70% of patients with RRMS. Adverse events occurred more frequently among women and among patients with lower body weight and lower BMI.

Frontiers in NeurologyVol. 17
Yeditepe University (TR), Sakarya University (TR), Van Yüzüncü Yıl Üniversitesi (TR), Dicle University (TR), Tekirdağ Namık Kemal University (TR), Sivas Cumhuriyet Üniversitesi (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Selçuk University (TR), Fırat University (TR), Karadeniz Technical University (TR), Manisa Celal Bayar University (TR), Bilkent University (TR), Süleyman Demirel Üniversitesi (TR), Başkent University (TR), Dokuz Eylül University (TR), Akdeniz University (TR), Adıyaman University (TR), Inonu University (TR), Ahi Evran University (TR), Taksim German Hospital (TR), Ondokuz Mayıs University (TR), Tokat Gaziosmanpaşa Üniversitesi (TR), Izmir Kâtip Çelebi University (TR), Zonguldak Bülent Ecevit University (TR), Kütahya Dumlupınar Üniversitesi (TR), Bezmiâlem Vakıf Üniversitesi (TR), Ege University (TR), Bakırköy Psychiatric Hospital (TR), Gülhane Askerî Tıp Akademisi (TR), Eskişehir City Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Haseki Eğitim ve Araştırma Hastanesi (TR), Akdeniz University Hospital (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Bağcılar Eğitim ve Araştırma Hastanesi (TR), Samsun University (TR), Alanya University (TR), Suleyman Demirel University (KZ), Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi (TR), Education Training And Research (US), Haydarpaşa Numune Eğitim ve Araştırma Hastanesi (TR), Izmir Bozyaka Eğitim ve Araştırma Hastanesi (TR), Ankara Yıldırım Beyazıt University (TR), Department of Public Health (MM), Şişli Etfal Eğitim ve Araştırma Hastanesi (TR), S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi (TR), Yildirim Beyazit University Yenimahalle Education and Research Hospital (TR), Ankara Etlik City Hospital (TR), Kırıkkale University (TR), Kahramanmaraş Sütçü İmam University (TR), Eskişehir Osmangazi University (TR), Kocaeli Üniversitesi (TR), Düzce Üniversitesi (TR), Gaziantep University (TR), Atatürk University (TR), Hacettepe University (TR), Marmara University (TR), Bolu Abant İzzet Baysal University (TR), Harran University (TR), Erciyes University (TR), Gazi University (TR)
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