The role of dimethyl fumarate (Tecfidera)

The mechanism of action of dimethyl fumarate (Tecfidera) in multiple sclerosis is not fully understood. It is thought to involve the degradation of dimethyl fumarate to its active metabolite monomethyl fumarate (MMF). Both dimethyl fumarate and MMF upregulate the nuclear factor (erythroid-derived 2)-like 2 (NRF 2) pathway, which is activated in response to oxidative stress. Dimethyl fumarate also suppresses pro-inflammatory genes by inhibiting nuclear factor kappa B. In addition, MMF is an agonist of nicotinic acid receptors, but its relevance is unclear. It has been suggested that dimethyl fumarate exerts its immunomodulatory effects by changing the composition and phenotype of immune cells.