|Jmol-3D images||Image 1|
|Molar mass||144.127 g/mol|
|Appearance||White crystalline solid|
|Density||1.37 g/cm³, solid|
|Melting point||102–105 °C|
|Boiling point||192–193 °C|
|EU classification||Harmful (Xn)|
|R-phrases||R21 R38 R41 R43|
|S-phrases||S26 S36 S37 S39|
|Related diesters||Diethyl fumarate, dimethyl maleate, dimethyl malonate, dimethyl adipate|
|Related compounds||Fumaric acid
|Except where noted otherwise, data are given for materials in their standard state (at 25 °C (77 °F), 100 kPa)|
|(what is: / ?)|
Dimethyl fumarate (DMF) is the methyl ester of fumaric acid. DMF was initially recognized as a very effective hypoxic cell radiosensitizer. Later, DMF combined with three other fumaric acid esters (FAE) was licensed in Germany as oral therapy for psoriasis (trade name Fumaderm). Other diseases, such as necrobiosis lipoidica, granuloma annulare, and sarcoidosis were also found to respond to treatment with DMF in case reports or small patient series. Phase III clinical trials found that DMF (BG-12) successfully reduced relapse rate and increased time to progression of disability in multiple sclerosis (trade name Tecfidera). DMF is thought to have immunomodulatory properties without significant immunosuppression.
In a non-medical use, DMF was applied as a biocide in furniture or shoes to prevent growths of mold during storage or transport in a humid climate. However, due to incidences of allergic reactions after skin contact the European Union banned DMF in consumer products since 1998, and since January 2009 the import of products containing DMF was also banned.
Dimethyl fumarate is an ester and an α,β-unsaturated electrophilic compound which can quickly undergo Michael additions with nucleophiles. Dimethyl fumarate is also an effective diene acceptor in the thermal Diels-Alder reaction, where the reactivity of its vinylenic bond is enhanced by the two electron-withdrawing ester groups. Due to the geometry of the starting ester, the Diels-Alder product will have a trans configuration. With this reaction, compounds with bicyclo skeletons can be synthesized, e.g. a diester with a norbornene (bicyclo[2.2.1]heptene) skeleton from dimethyl fumarate and cyclopentadiene.
Mechanism of action
Dimethyl fumarate is a lipophilic, highly mobile molecule in human tissue. As a α,β-unsaturated electrophilic compound, dimethyl fumarate is rapidly attacked by the detoxifying agent glutathione (GSH) in a Michael addition reaction. Dimethyl fumarate is highly reactive: when administered orally, it does not survive long enough to be absorbed into blood without being attacked by GSH. However, part of it is hydrolyzed by esterases to produce monomethylfumarate, which is more resistant. GSH depletion and subsequent induction of the anti-inflammatory stress protein HO-1 is thought to be one of the mechanisms responsible for the immunomodulatory actions of DMF.
Other postulated mechanisms of action include direct cytoprotective effects through upregulation of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and subsequent induction of an antioxidant response.
The medical use of fumaric acid esters (FAE) was first described in 1959 by the German chemist W. Schweckendiek who reported on successful internal and external treatment of his own psoriasis. Later, various controlled clinical trials confirmed the effectiveness of FAEs in psoriasis  and in 1994 a defined mixture of DMF and the Ca, Mg and Zn salts of the corresponding monoethylester, ethylhydrogen fumarate, was registered in Germany (Fumaderm, Fumapharm AG; now owned by Biogen Idec, Inc.). Long-term studies have established the safety of FAE without an increased risk of infections, malignancies, or significant long-term toxic effects, which are often seen with alternative systemic psoriasis therapies such as methotrexate or cyclosporine. A recent reports suggest a positive effect of continuous systemic anti-psoriatic therapy with FAE on the risk for cardiovascular disease. The most common side effects seen with the medical use of FAE are gastro-intestinal symptoms and flushing, which can be the cause of treatment discontinuation in some patients. However, often these tolerability issues are self-limiting or can be mitigated by dose adaptation and appropriate patient counseling. Upon stopping of drug administration the symptoms will disappear within a few days. A possible link to DMF treatment and the rare but serious brain disease, progressive multifocal leukoencephalopathy (PML), has been noted.
Today, FAE are the most frequently prescribed medication for systemic treatment of psoriasis in Germany. Apparently no attempts were made to receive marketing authorizations outside of Germany, however, FAE are also frequently used in other European countries on an off-label basis, and European and US guidelines include FAE in their recommendations of first-line therapies for moderate to severe psoriasis.
FAE were also found to be effective in other conditions, including necrobiosis lipoidica, granuloma annulare, sarcoidosis, alopecia areata, cheilitis granulomatosa, recurrent oral aphthae, pityriasis rubra pilaris, annular elastolytic giant-cell granuloma or non-infectious chronic uveitis.
Pre-clinical studies and clinical trials have indicated that DMF is the most active FAE and that the additional FAE salts in the combination product Fumaderm are not required.
An FAE drug product containing only DMF is now in late stage clinical development: The Danish company Forward Pharma A/S develops a small tablet containing DMF (FP187) for the treatment of moderate to severe psoriasis. The American company Biogen Idec developed DMF as a capsule containing microtablets for the treatment of multiple sclerosis, under the code name BG-12; it was approved for sale as Tecfidera on March 27, 2013. Tecfidera was shown to have a significant effect on relapse rate and time to progression in phase III clinical trials.
DMF was recommended for approval in the European Union as a peroral treatment for MS by EMA March 21, 2013 under the name Tecfidera. On March 27, 2013 FDA approved Tecfidera capsules to treat adults with relapsing forms of MS.
Dimethyl fumarate has been found to be an allergic sensitizer at very low concentrations, producing eczema that is difficult to treat. Concentrations as low as 1 ppm may produce allergic reactions. There are only a handful of equally potent sensitizers.
The sensitizing risk was brought to public attention by the "poison chair" incident, where Chinese manufacturer Linkwise produced two-seater sofas with dimethyl fumarate sachets inside to inhibit mould while they were in storage or transport. In Finland where the chairs were sold from 2006–2007, sixty users were given serious rashes. The cause was identified as dimethyl fumarate-induced allergic reaction by Tapio Rantanen from Finland, and his original article became the cover story in the July issue of the British Journal of Dermatology. In the United Kingdom, sofas sold by Argos, Land of Leather and Walmsley Furnishing containing the chemical caused over a hundred injuries. Argos withdrew the sofas from stores and contacted buyers to collect those that had been sold — with Land of Leather withdrawing the sofas without notifying buyers and Walmsley saying they had removed the sachets from sofas they sold after the danger came to light. Complaints have been made that dates on the sofas were altered and sofas containing the sachets sold. Land of Leather and Walmsley are facing a ₤10 million class action suit over their reaction to the incident, joining the manufacturer in denying the sofas are connected to their customers injuries. The danger came to public attention when the BBC Watchdog program alerted consumers to the sofas.
In the European Union the use of dimethyl fumarate for consumer products has been forbidden since 1998, and since January 2009 the import of products containing dimethyl fumarate is also forbidden.
The EU Commission Decision 2009/251 of 17 March 2009 requiring Member States to ensure that products containing the biocide dimethylfumarate are not placed or made available on the market has definitely forbidden any marketing of products containing dimethyl fumarate into the European Union. The ban on dimethyl fumarate as laid down in Decision 2009/251 establishes a maximum concentration of dimethyl fumarate in products of 0.1 ppm. Products containing more than 0.1 ppm dimethyl fumarate shall be withdrawn from the market and recalled by consumers as of 1 May 2009.
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