What is the recommended protocol for switching from Vumerity (diroximel fumarate) to Tecfidera (dimethyl fumarate)?

Switching from Vumerity to Tecfidera: Recommended Protocol

Vumerity (diroximel fumarate) can be directly switched to Tecfidera (dimethyl fumarate) without a washout period, as both medications share the same active metabolite (monomethyl fumarate) but have different tolerability profiles.

Understanding the Medications

• Both Vumerity (diroximel fumarate) and Tecfidera (dimethyl fumarate) are oral fumarate therapies that work through the same active metabolite, monomethyl fumarate 1, 2
• Vumerity 462 mg and Tecfidera 240 mg produce bioequivalent exposure of the active metabolite, meaning they should have similar efficacy profiles 3
• The main difference between the two medications is their gastrointestinal tolerability profile, with Vumerity demonstrating fewer gastrointestinal side effects 3, 4

Switching Protocol

• Direct switch approach: Since both medications share the same active metabolite, patients can switch directly from Vumerity to Tecfidera without a washout period 3, 5
• Dosing equivalence: Switch from Vumerity 462 mg twice daily to Tecfidera 240 mg twice daily 3
• Timing: The switch can occur at the next scheduled dose 5

Monitoring After Switching

• Monitor for increased gastrointestinal symptoms in the first few weeks after switching, as Tecfidera has a higher incidence of GI side effects compared to Vumerity 3, 4
• Continue regular laboratory monitoring as recommended for fumarate therapies 6:
  • Urinalysis and serum chemistry profile including renal function tests every 2 weeks for the first month
  • Monthly monitoring for the first 6 months
  • Bimonthly monitoring thereafter

Managing Side Effects After Switching

• Gastrointestinal symptoms (abdominal pain, nausea, diarrhea) are more common with Tecfidera than Vumerity 3, 4
• Flushing may occur in approximately one-third of patients 7
• Management strategies for increased side effects:
  • Taking medication with food may reduce GI symptoms 6
  • Temporary dose reduction may be considered if symptoms are severe 7
  • Symptomatic medications may be needed more frequently with Tecfidera than with Vumerity (30.6% vs 19.3% of patients with GI symptoms) 4

Special Considerations

• Discontinuation risk: Be aware that the discontinuation rate due to gastrointestinal adverse events is higher with Tecfidera (4.8%) compared to Vumerity (0.8%) 4
• Quality of life impact: Patients may experience more interference with daily activities and work productivity after switching to Tecfidera 4
• Lymphopenia monitoring: Continue monitoring for lymphopenia, which can occur with both medications 7

Common Pitfalls to Avoid

• Not preparing patients for potential increased GI side effects: Patients should be informed that they may experience more GI symptoms after switching from Vumerity to Tecfidera 3, 4
• Failing to provide symptom management strategies: Proactively discuss management strategies for GI symptoms and flushing 6
• Neglecting continued monitoring: Maintain the same laboratory monitoring schedule after switching medications 6