Dr.B discusses how Tecfidera works in MS on periscope

Dr.B reviews how Tecfidera (dimethyl fumerate) works to treat multiple sclerosis. This is an oral pill taken twice daily for relapsing forms of multiple sclerosis. (Recorded LIVE via PERISCOPE)
Tecfidera plays a trick on the cells. By stimulating the NEF2 pathway, it tricks cells into thinking they are under oxidative stress. As a result the tricked cells respond with an anti-oxidant cascade that ultimately slows down MS disease activity! Fascinating and novel mechanism of action.
Please leave your comments and questions below!
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[@CapricornSister13]

Oh wow that's fascinating! Thank you! I've been on Tecfidera twice a day for 4 years. I wish I had a neuro that would take the time to explain things to me better. Think I need a new neuro...

[@Petra44YT]

Oh, thanks for explaining! ... I've been taking Tecfidera for about ten years now, and finally, someone told me how it actually works. :-)

[@Itsme1.]

I’m 22 and just got diagnosed with MS 2 months ago , I started with Tecfidera and hope it works well with me

[@luvdaband6018]

I just started taking it also.. I hope it does well for me also

[@Shark999i]

How are you now on tec??

[@Itsme1.]

@@Shark999i really good it’s been 9 months

[@Shark999i]

@@Itsme1. when its start working for you and feel better?

[@Shark999i]

@@Itsme1. i am glad to hear that ❤

[@suebarnes2793]

Love tecfidera been on it for several years Its amazing.

[@lorraineallbutt4504]

Good to hear 🌈stay well 👍

[@waynesalvador9925]

Been on it for a month. And it works👍👍👍👍

[@courtneycarone]

im on tecfidera. i love it.

[@jorgem2331]

Hoping to get started on Tecfidera. Diagnosed ten months ago and as of now not on any medication. Thank you for your time.

[@AaronBosterMD]

Right on Jorge! #WeHaveMS

[@LITTLEMUSTANGFILLY]

I'm on 120mg once a day right now. I was barfing constantly when we went to the higher dose. So we're just taking things way slower.

[@Siouxsiebecksable]

Hi everyone, I am on day 3. The first 2 days were great some itching but that was it. Now today I am feeling like I have been hit by a truck. Feels like a bad flu without the head cold or sore throat. Has anyone else experienced this?

[@buffalobob870]

Thanks for you comments on Tecfidera as I'm currently on this...love your videos and plug your name to anyone interested in another point of view! As I'm contemplating switching therapies, is there a resource or even you own practice of "washout" periods for various medications...as I understand it, Tecfidera does not stay in your system very long, so I'd think a long "washout" period could invite the return of disease activity...Your insights or resources would be appreciated

[@AaronBosterMD]

This would make a good video topic I think!

[@buffalobob870]

yes it would...I've been scouring the internet for information and seems to be a judgement call based on a number of factors depending on what is be switched to and from and the relative health of the immune system. To me, it is a very important choice as I've had most of my disease activity 3-4 months following starting a DMT and most have just the voice ( a very important one) from their neurologist

[@dennyweinberg1923]

Hello, thanks for the video. Would it be possible to give your opinion about Tecfidera vs. Ocrevus regarding side effects, PML risk, long term support...? I have RRMS and take Tecfidera for around 2 years, but I have stomach issues (and fatigue). Thanks

[@AaronBosterMD]

My opinion is that Ocrevus is a highly effective DMT and Tecfidera is a moderately effective DMT. I have videos that review side effects and safety on both drugs (look under the "How do MS Drugs Work" playlist!)

[@moonlookingforthesun1866]

I'm on half dose. One pill a day, have you ever heard about it?

[@Katie-vy5rd]

I am a nurse and have a pt that I give meds to, Tecfidera, and have tried to help him understand his need diagnosis and the pharmacodynamics and kinetics of this med as he has is discouraged by the side effects currently 2 weeks in on his taper up dose. He doesn't have unlimited resources as this is in a prison setting. I've been trying to gather helpful info but the only thing I've found is that it helps to take with food and the active metabolite's half life is about an hour this past part not so helpful. And an aside is that dimethyl fumarate is available, in which setting i don't know, for about $50 per metric ton! ... is it very helpful to separate the doses ? Eg. 120 BID vs 240 QD as far as side effects go? Thanks so much in advance!! And can he expect side effects to abate after a few more days? Weeks? Months?

[@athenasheffield2836]

Thank you for explaining how Tecfidera works (as wellas other drugs in different videos). I've been on Tecfidera for 4 or so years, and though it was rough in the beginning, and it is working amazingly for me. My black holes are virtually nonexistent (that one stumped me and my neuro couldn't believe it so she pulled up an old MRI and compared them side by side). I'm no longer bothered by the flushing other than once in a while. While I'm singing Tecfidera's praises, I must admit to one MAJOR delinquency; the instructions on the insert specifically state not to open the capsule, but unfortunately I'm too inquisitive and opened one and was tickled to find little bitty Barbie marshmallows inside. Can you please tell me how often I should be having labs done? What about the JCV test? I'm JCV+ and haven't been retested since diagnosed, but I sometimes wonder if the levels can fluxuate. I'm so glad I found your KZbin page and thanks again!

[@AaronBosterMD]

Athena, Here's a video I did on this topic recently: kzbin.info/www/bejne/imSof6R6g5WEbMk Generally speaking most recommend labs (complete blood counts and liver function tests) every 3-6 months. The JCV antibody test isn't "indicated" for use with interpreting PML risk with Tecfidera. That said, many of us check it, but that's very provider/center specific. I think it's awesome that you opened a capsule and found little bitty Barbie marshmallows!

[@LITTLEMUSTANGFILLY]

I opened one too lol. Curiosity got the better of me. 😂

[@shalinidhir5335]

Please make a video on aubagio...teriflunomide Is it better than tacfidera??? Waiting for ur reply.

[@AaronBosterMD]

1. studio.kzbin.infoWi7Ta8z9uEk/edit?Fmy_videos 2. studio.kzbin.infoDvUnjCwS_fI/edit?Fmy_videos 3. studio.kzbin.infoeFVkRIMuhDM/edit?Fmy_videos

[@sstojsin]

The main question about Tecfidera is, why is it so expensive(?)... When you consider, dimethyl fumarate it self is very cheap. 500 or so US dolars per kg i believe? With 1kg, you can make almost lifetime of supply of pills with it. So far, i've managed to find out it's all about acid resistant capsules, since once dimethyl enters human body, it does some funky stuff to it. Heck, it even makes skin reacts to it. But, once it enters small intestines it's not that volatile, or is it delayed release of it, or both combined? But it is good pathway, better to digest pills then to pin yourself almost every day untill the rest of your life. I hate niddles, not very fond of them.

[@AaronBosterMD]

Pills are certainly easier to take than needles Sasa!

[@rosered3919]

​@@difranophile I want to talk with people like yourself on MS topic. Would appreciate any leads or links. Thankyou

[@juanquirarte3091]

how's Tecfidera in 2020? I know this is an old video, I'm in Tecfidera for 6 months now, and my Neurologist, toll me my last MRI is worst than the one before;

[@SaucyNetworkEntertainment]

the medicine takes about 6 months to fully become active. so the first MRI after 6 months is your baseline.

[@junior10199]

Why is there not more polypharmacy in ms? Glatiramir acetate is relatively innocuous, right? Why not take it with another disease modifying med?

[@momtazjee]

coming off betaseron and looking to see if I get the go ahead to start BG12, what is the lymphocytes levels to watch out for ? they can’t be below a certain level?

[@AaronBosterMD]

I would talk to your MS provider about this one. We often are concerned when absolute lymphocyte counts go below 0.8, but everyone is different. Worth discussing at your next visit with your MS provider for sure!

[@momtazjee]

That’s good to know Aaron, I will certainly ask about next follow up.

[@AaronBosterMD]

#WeHaveMS

[@samahelleacy4132]

Hi DR How long I can take TYSABRI( JC virus negative)? Thank you

[@doctorken2k]

Would you go with Copaxone or Tecfidera.

[@AaronBosterMD]

I have a video on my opinions of Copaxone in 2018: kzbin.info/www/bejne/iZWZan6jetWmja8

[@mrsminnamorato]

There’s mannitol, a gluten/wheat derivative in Copaxone. With me being highly gluten/wheat/celiac sensitive, I had horrible experiences while on it and thus quit while firing my neurologist because how do you advise and encourage a patient to take something before due diligence and knowledge of my sensitivity? We trust physicians for this, but so thankful I did my own as my RRMS was progressively worsening. So, in my personal experience, if you have any type of reaction to wheat/manna, or a derivative of manna such as mannitol, stay away from Copaxone. I’m currently on Tecfidera and I feel much better. Good luck and blessings to you with your decision as well as your future health!

[@momtazjee]

Hi Dr.Boster would tecfidera help in lowering my edss my latest is 4.5 which is alarming right now.

[@AaronBosterMD]

Howdy Vick! Tecidera and all the other DMTs are primarily intended to decrease or prevent FUTURE MS damage, but not really to give back damage that has already occurred. There are some small percentages of PwMS in clinical trials that experienced confirmed disability improvement. CDI is not a "strong suit" with tecidera but that doesn't mean it's not possible. I would just not personally choose this specific medication for that specific reason. Here's a video on CDI: kzbin.info/www/bejne/iorZlaGrochkic0

[@finnajane]

nerf football pathway? 😉

[@dimitrabardemi210]

I am on avonex I am thinking of tecfidera as new option and more affective I guess.I have low lymphocytes .Is that regular happened on avonex?