Real-World Safety and Effectiveness of Dimethyl Fumarate in Black or African American Patients with Multiple Sclerosis: 3-Year Results from ESTEEM

Mitzi J. Williams, Lilyana Amezcua, Annette Okai, Darin T. Okuda, Stanley Cohan, Ray Su, Becky Parks, Jason P. Mendoza, James B. Lewin, Cynthia C. Jones

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Introduction: Black or African American (black/AA) patients with multiple sclerosis (MS) are reported to exhibit greater disease severity compared with non-black or non-AA patients. Whether differences exist in response to MS disease-modifying therapies remains uncertain, as MS clinical trials have included low numbers of non-white patients. We evaluated real-world safety and effectiveness of dimethyl fumarate (DMF) on MS disease activity in black/AA patients. Methods: ESTEEM is an ongoing, 5-year, multinational, prospective study evaluating long-term safety and effectiveness of DMF in patients with MS. This interim analysis included patients newly prescribed DMF in routine practice at 394 sites globally. Results: Overall, 4897 non-black/non-AA and 187 black/AA patients were analyzed; median (range) follow-up 18 (2–37) months. Unadjusted annualized relapse rates (ARRs) for 12 months before DMF initiation versus 36 months post DMF initiation, respectively, were: non-black/non-AA patients, 0.83 (95% CI 0.80–0.85) versus 0.10 (95% CI 0.09–0.10), 88% lower ARR (P < 0.0001); black/AA patients, 0.68 (95% CI 0.58–0.80) versus 0.07 (95% CI 0.05–0.10), 90% lower ARR (P < 0.0001). In total, 35 (19%) black/AA patients reported adverse events leading to treatment discontinuation; gastrointestinal disorders were most common (7%), consistent with non-black/non-AA patients (8%). Median lymphocyte counts decreased by 22% in the first year (vs 36% in non-black/non-AA patients), then remained stable and above lower limit of normal in most patients. Conclusions: Relapse rates remained low in black/AA patients, consistent with non-black/non-AA patients. The safety profile of DMF in black/AA patients was consistent with that in the non-black/non-AA ESTEEM population, although lymphocyte decrease was less pronounced in black/AA patients.

Original languageEnglish (US)
Pages (from-to)483-493
Number of pages11
JournalNeurology and Therapy
Issue number2
StatePublished - Dec 1 2020


  • Dimethyl fumarate
  • Multiple sclerosis
  • Safety and effectiveness

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


Dive into the research topics of 'Real-World Safety and Effectiveness of Dimethyl Fumarate in Black or African American Patients with Multiple Sclerosis: 3-Year Results from ESTEEM'. Together they form a unique fingerprint.

Cite this