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Updated: Oct 9, 2025
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Introducing a simplified titration scheme for dimethylfumarate (DMF) in patients with moderate-to-severe psoriasis: a
Ralph von Kiedrowski1, Sebastian Diemert2
1Dermatological Practice, Selters, Germany.
Abstract:
Dimethylfumarate (DMF) is approved for the treatment of moderate to severe psoriasis. In clinical practice, DMF tolerability is improved by slowly up-titrating the dose. Time-to-onset of gastrointestinal complaints (a common adverse event [AE]) is ∼4 weeks, coinciding with the increase in dose to one 120-mg tablet. The average DMF dose during maintenance treatment is also often lower than the maximum indicated dose of 720 mg/day. Here, a simplified dose-escalation strategy is described, where twice-daily DMF was up-titrated to a maximum of 720 mg/day (if required) in week 7. Ten patients received DMF according to the new scheme (maximum dose: 720 mg/day [n = 5], 480 mg/day [n = 3; escalation halted early due to good efficacy], and ≤240 mg/day [n = 2] by week 12). Mean Psoriasis Area Severity Index (PASI) decreased from 7.2 to 0.9 between weeks 0 and 24. Absolute Psoriasis Area Severity Index (aPASI) was ≤3 for 7 and 6 patients at weeks 12 and 24, respectively. Affected BSA and DLQI demonstrated similar improvements. Treatment was terminated in 3 patients due to AEs (diarrhea and lymphopenia). In this case series, simplified DMF dosing was largely well-tolerated and provided similar efficacy to the current scheme. Higher doses were reached more quickly and the dosing regimen was simpler for patients (twice instead of three times daily).
Insights
A simplified dosing schedule for dimethylfumarate (DMF) in psoriasis treatment was well-tolerated and effective. This new approach allowed patients to reach higher doses faster with a simpler regimen, improving overall management.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Therapeutics
Background:
- Dimethylfumarate (DMF) is an established treatment for moderate to severe psoriasis.
- Current clinical practice involves slow dose titration of DMF to manage gastrointestinal adverse events (AEs).
- Gastrointestinal AEs often emerge around week 4, coinciding with dose increases, and maintenance doses are frequently below the maximum 720 mg/day.
Purpose of the Study:
- To evaluate a simplified, accelerated dose-escalation strategy for oral dimethylfumarate (DMF) in psoriasis patients.
- To assess the tolerability, efficacy, and patient simplicity of the new DMF dosing regimen compared to standard titration.
- To determine if higher DMF doses can be achieved more rapidly and safely.
Main Methods:
- A simplified, twice-daily DMF dose-escalation regimen was implemented, aiming for a maximum of 720 mg/day by week 7.
- Ten patients with psoriasis received DMF according to the new scheme, with final doses varying based on efficacy and tolerability.
- Psoriasis Area Severity Index (PASI), absolute PASI (aPASI), body surface area (BSA) involvement, and Dermatology Life Quality Index (DLQI) were assessed over 24 weeks.
Main Results:
- Mean PASI scores decreased significantly from 7.2 at baseline to 0.9 at week 24.
- A substantial proportion of patients achieved low aPASI scores (≤3) by weeks 12 and 24 (7/10 and 6/10, respectively).
- Improvements in BSA and DLQI were also observed; however, three patients discontinued treatment due to AEs (diarrhea, lymphopenia).
Conclusions:
- The simplified DMF dosing strategy was largely well-tolerated and demonstrated comparable efficacy to the current standard titration scheme.
- This accelerated regimen allowed for quicker achievement of higher DMF doses and offered a simpler, twice-daily dosing schedule for patients.
- The simplified approach may enhance patient adherence and treatment outcomes in managing moderate to severe psoriasis.
