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Updated: Nov 2, 2025
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Dimethyl fumarate titration for the systemic treatment of moderate-to-severe plaque psoriasis
Giovanna Malara1, Gabriella Fabbrocini2, Caterina Trifirò1
1Dermatology Department, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Background:
Dimethyl fumarate (DMF) is an oral systemic agent approved for the treatment of moderate-to-severe psoriasis vulgaris. It has a favourable tolerability profile, but it is associated with a high incidence of mild and reversible adverse events. The aim of the article is to describe a clinical experience aimed at increasing tolerability.
Patients And Methods:
A group of patients was treated with DMF with a titration schedule, according to clinical practice, although a personalization of the step-up timing was allowed. The highest dose was the minimal effective dose or the maximal tolerated doses.
Results:
DMF treatment was effective in reducing the disease severity and improving the quality of life. DMF was well tolerated as only mild, mainly gastrointestinal, adverse events occurred in these patients. In addition, the up-titration schedule seemed to provide a reduced incidence of adverse events compared with the fixed dose.
Conclusion:
Our experience suggested that the recommended up-titration schedule of DMF, adjusted and personalized according to patient needs and physician opinion, provided a relevant clinical benefit and was well tolerated.
Insights
Personalized titration of dimethyl fumarate (DMF) effectively treats psoriasis while improving tolerability. This approach reduces adverse events, enhancing patient quality of life.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Medicine
Background:
- Dimethyl fumarate (DMF) is an oral systemic treatment for moderate-to-severe psoriasis vulgaris.
- While effective, DMF is linked to frequent mild, reversible adverse events.
- Clinical experience is presented to enhance DMF tolerability.
Purpose of the Study:
- To evaluate a personalized titration schedule for dimethyl fumarate (DMF) in psoriasis treatment.
- To assess the impact of this schedule on treatment efficacy and tolerability.
- To describe clinical experience in managing DMF therapy.
Main Methods:
- Patients received DMF using a titration schedule with personalized step-up timing.
- The maximum dose was determined by minimal effective dose or maximal tolerated dose.
- Clinical practice guided the titration process.
Main Results:
- DMF treatment demonstrated efficacy in reducing psoriasis severity and improving quality of life.
- DMF was well-tolerated, with predominantly mild gastrointestinal adverse events.
- The up-titration schedule appeared to reduce adverse event incidence compared to fixed dosing.
Conclusions:
- A personalized, up-titration schedule for DMF, adapted to patient needs and physician judgment, offers significant clinical benefit.
- This individualized approach to DMF therapy enhances patient tolerability.
- The study suggests DMF titration is a well-tolerated and effective treatment strategy for psoriasis.
