Reactions 1680, p77 - 2 Dec 2017 Calcium monoethyl fumarate/dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate Various toxicities: 3 case reports In a retrospective case study, three women, aged 39 46 years were described who developed transient lymphopaenia, flushing, proteinuria or worsening renal function during therapy with calcium monoethyl fumarate/ dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate [Fumaderm; route not stated; not all outcomes stated]. Case 1: The 46-year-old woman presented with a five year history of systemic lupus erythematosus (SLE) with disseminate discoid lupus erythematosus (DLE) lesions. She had received several topical and systemic therapies which failed to control her cutaneous manifestations. Subsequently, she started receiving calcium monoethyl fumarate/dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate 30mg thrice daily. Within weeks of initiation of therapy, clinical improvements were evident with complete cutaneous disease inactivity after five months and decrease in dermatology life quality index (DLQI) scores. However, her SLE associated haemolytic anaemia was unaffected. Her adverse effects with therapy included a transient lymphopaenia which resolved within four weeks. Her treatment with calcium monoethyl fumarate/dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate was continued. Case 2: The 42-year-old woman presented with a 15 years of history of systemic lupus erythematosus (SLE) which manifested as severe chilblain lupus erythematosus (CHLE). Previous treatment with topical corticosteroids failed to control the symptoms. Finally, she started receiving calcium monoethyl fumarate/dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate 120mg four times daily which led to significant improvements in the symptoms. However, she developed side effects which included mild flushing, mild transient lymphopaenia and new proteinuria with no dose reduction for 20 months. Her lymphopaenia occurred after 12 months of therapy and recovered spontaneously after 8 weeks. Case 3: The 39-year-old woman presented with a six year history of therapy resistant cutaneous manifestations including chilblain lupus erythematosus (CHLE) lesions and oral ulcers. She had received treatment with topical corticosteroids, keratolytics and humectants which failed to improve the symptoms. She was started on therapy with calcium monoethyl fumarate/dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate 240mg thrice a day. However, before the start of this therapy, she had declining renal function and proteinuria with previous biopsy proven lupus nephritis. Her renal function continued to fluctuate after initiation of calcium monoethyl fumarate/ dimethyl fumarate/magnesium monoethyl fumarate/zinc monoethyl fumarate with no significant overall decline. Following 24 months of high dosing, the dose was reduced. Her systemic symptoms including fatigue did not improve on this therapy. Author comment: "With regards adverse effects, this patient developed a transient lymphopaenia (0.78x109/L) early in FAE therapy". "This patient developed mild flushing, a mild transient lymphopaenia and new proteinuria. . .". "Declining renal function and proteinuria predated [fumaric acid esters] introduction in this patient, with previous biopsy proven lupus nephritis. Renal function has continued to fluctuate since FAE introduction, but with no significant overall decline." Saracino AM, et al. Severe recalcitrant cutaneous manifestations in systemic lupus erythematosus successfully treated with fumaric acid esters. British Journal of Dermatology 176: 472-480, No. 2, Feb 2017. Available from: URL: http:// doi.org/10.1111/bjd.14698 - United Kingdom 803284115 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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