Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Fumaric acid esters, particularly dimethyl fumarate (DMF), have a well-established scientific basis for their use in the treatment of certain autoimmune disorders, most notably multiple sclerosis (MS) and psoriasis. DMF is an FDA- and EMA-approved oral medication for relapsing forms of MS and moderate-to-severe plaque psoriasis. The evidence supporting its efficacy in these conditions comes from multiple large-scale, randomized controlled trials (e.g., DEFINE, CONFIRM for MS; BRIDGE, ESTEEM for psoriasis) that have demonstrated its ability to reduce disease activity, relapse rates, and lesion formation in MS, as well as to improve skin lesions in psoriasis. The proposed mechanism of action of fumaric acid esters involves modulation of the immune system, particularly through activation of the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway, which reduces oxidative stress and inflammation. Fumaric acid esters also appear to shift T-cell populations from a pro-inflammatory to an anti-inflammatory phenotype, further supporting their use in autoimmune conditions. Although DMF and related fumaric acid esters are not used for all autoimmune disorders, there is robust, high-quality evidence for their use in MS and psoriasis. They are not generally used for other autoimmune diseases such as rheumatoid arthritis or lupus. Overall, the use of fumaric acid derivatives in these specific autoimmune conditions is justified by strong scientific validation.

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