Methods of treating multiple sclerosis
Provided herein are methods of treating multiple sclerosis with a fumarate, wherein the fumarate is a dialkyl fumarate, a monoalkyl fumarate, a combination of a dialkyl fumarate and a monoalkyl fumarate, a prodrug of monoalkyl fumarate, a deuterated form of any of the foregoing, or a pharmaceutically acceptable salt, clathrate, solvate, tautomer, or stereoisomer of any of the foregoing, or a combination of any of the foregoing. The methods provided herein improve the safety of treatment by informing and monitoring patients undergoing treatment regarding progressive multifocal leukoencephalopathy, and/or by monitoring lymphocyte count.
1. A method of treating a patient with multiple sclerosis, comprising the steps of:
(a) administering a pharmaceutical composition comprising a fumarate to the patient; wherein the fumarate is dimethyl fumarate, monomethyl fumarate or a combination of dimethyl fumarate and monomethyl fumarate; with the provisos (i) that a fumarate salt is not present in the pharmaceutical composition and (ii) that no additional fumarate other than dimethyl fumarate or monomethyl fumarate is present in the pharmaceutical composition;
(b) obtaining a complete blood count including lymphocyte count after 6 months of repeated administering of said pharmaceutical composition to said patient, and every 6 to 12 months thereafter;
(c) interrupting administering of said pharmaceutical composition to said patient when the patient has a lymphocyte count less than 0.5×10 9 /L persisting for more than six months; and
(d) monitoring the patient for a sign or symptom suggestive of progressive multifocal leukoencephalopathy (PML) in the patient.
2. The method of claim 1 , wherein the fumarate is a combination of dimethyl fumarate and monomethyl fumarate.
3. The method of claim 1 , wherein the fumarate is dimethyl fumarate.
4. The method of claim 1 , wherein the fumarate is monomethyl fumarate.
5. The method of claim 1 , wherein the administering is done orally.
6. The method of claim 3 , wherein the administering is of 240 mg dimethyl fumarate twice daily orally.
7. The method of claim 5 , wherein the administering is of not greater than 480 mg daily total fumarates.
8. The method of claim 1 , wherein the sign or symptom suggestive of PML, is selected from the group consisting of progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.
9. The method of claim 1 , wherein the patient exhibits a sign or symptom suggestive of PML, and the method further comprises withholding the pharmaceutical composition and performing an appropriate diagnostic evaluation for PML.
10. The method of claim 1 , wherein the method further comprises informing the patient that PML has occurred in a patient who received dimethyl fumarate.
11. The method of claim 3 , wherein the administering is of 120 mg dimethyl fumarate twice daily orally for 7 days, followed by 240 mg dimethyl fumarate twice daily orally as a maintenance dose.
12. The method of claim 5 , wherein the sign or symptom suggestive of PML is selected from the group consisting of progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.
13. The method of claim 5 , wherein the patient exhibits a sign or symptom suggestive of PML, and the method further comprises withholding the pharmaceutical composition and performing an appropriate diagnostic evaluation for PML.
14. The method of claim 6 , wherein the sign or symptom suggestive of PML is selected from the group consisting of progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.
15. The method of claim 6 , wherein the patient exhibits a sign or symptom suggestive of PML, and the method further comprises withholding the pharmaceutical composition and performing an appropriate diagnostic evaluation for PML.
16. The method of claim 7 , wherein the sign or symptom suggestive of PML is selected from the group consisting of progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.
17. The method of claim 7 , wherein the patient exhibits a sign or symptom suggestive of PML, and the method further comprises withholding the pharmaceutical composition and performing an appropriate diagnostic evaluation for PML.
18. The method of claim 11 , wherein the sign or symptom suggestive of PML is selected from the group consisting of progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes.
19. The method of claim 11 , wherein the patient exhibits a sign or symptom suggestive of PML, and the method further comprises withholding the pharmaceutical composition and performing an appropriate diagnostic evaluation for PML.
20. The method of claim 2 , wherein the administering is done orally.
21. The method of claim 3 , wherein the administering is done orally.
22. The method of claim 4 , wherein the administering is done orally.