Health Boards
Mon-22-12-2014, 22:05 PM
Summary
That fumarates are effective with psoriasis is with researchers already a fact. There is still some distress and nescience about which fumarates are usable and which are not. Also the working principle is in discussion. Because of that, there is a difference in view on the possible harmful side effects of the diverse fumarates, about the indication area and about the type of doctors who should prescribe this treatment.
This appears also from the report of the Commission Pharmaceutical Help from 2004 (Dutch), where a) Monoethyl as well as dimethylesters of fumaric acid are mentioned as usable medications, where b) Immuno suppression is seen as a sufficient explanation for the treatment result and where c) fumarate treatment, because of possible harmful side effects is limited to psoriasis patients where all other medications have failed, under the additional limit that this may only be prescribed by a dermatologist (C: in the mean time there is more space in the prescription possibilities, at least in the Netherlands. The report has been rewritten)
The conclusions on this report however are missing a scientific basis (C: yeah, written by a Committee can never be scientific....
) At first, based on literature research in prevalent posts we have shown that monoethylfumarates do not work with psoriasis and that they pose more risk for the health than dimethylfumarate.
Secondly there is still no proof that immunomodulation, as well as suppression is the definitive explanation for the positive effect of fumarate with psoriasis. Sunlight is also very favorable for the skin with psorisis, but nobody will state that this has to do with immunosuppression. On the contrary, sunlight means an addition of energy in the form of photons and normally stimulates the immune system. Also the reduction of stress has a positive influence on psoriasis and that also has nothing to do with immunosuppression.
According to the original author of this information, it cannot be ruled out that psoriasis is based on a mitochondrial disfunction which is normalized by the use of the fumarate treatment. Because of the fact that above that the indication area of fumarate is much broader than solely the treatment of psoriasis, the use of fumarates ought not to be limited the specialistical, dermatological practice, as the mentioned report states (C: the committee report).
The original author points in this situation to the fact that according to US patent 6858750 (2005) the medical use of fumarate, based on extensive literature study is claimed for the treatment of all possible mitochondrial diseases.
Finally the harmless side effects and the favourable long term effects of fumarates, as shown by Litjens, are strong arguments to use fumarates as a first choice treatment of manifest psoriasis, specifically as dimethylfumarate in slow release form.
A solid medical supervision with the treatment is necessary, that is obvious, but there is no scientifically based reason why this supervision could not be done by a GP.
There is a lot of research literature. I don't have that, but I can give references if necessary.
That fumarates are effective with psoriasis is with researchers already a fact. There is still some distress and nescience about which fumarates are usable and which are not. Also the working principle is in discussion. Because of that, there is a difference in view on the possible harmful side effects of the diverse fumarates, about the indication area and about the type of doctors who should prescribe this treatment.
This appears also from the report of the Commission Pharmaceutical Help from 2004 (Dutch), where a) Monoethyl as well as dimethylesters of fumaric acid are mentioned as usable medications, where b) Immuno suppression is seen as a sufficient explanation for the treatment result and where c) fumarate treatment, because of possible harmful side effects is limited to psoriasis patients where all other medications have failed, under the additional limit that this may only be prescribed by a dermatologist (C: in the mean time there is more space in the prescription possibilities, at least in the Netherlands. The report has been rewritten)
The conclusions on this report however are missing a scientific basis (C: yeah, written by a Committee can never be scientific....
) At first, based on literature research in prevalent posts we have shown that monoethylfumarates do not work with psoriasis and that they pose more risk for the health than dimethylfumarate. Secondly there is still no proof that immunomodulation, as well as suppression is the definitive explanation for the positive effect of fumarate with psoriasis. Sunlight is also very favorable for the skin with psorisis, but nobody will state that this has to do with immunosuppression. On the contrary, sunlight means an addition of energy in the form of photons and normally stimulates the immune system. Also the reduction of stress has a positive influence on psoriasis and that also has nothing to do with immunosuppression.
According to the original author of this information, it cannot be ruled out that psoriasis is based on a mitochondrial disfunction which is normalized by the use of the fumarate treatment. Because of the fact that above that the indication area of fumarate is much broader than solely the treatment of psoriasis, the use of fumarates ought not to be limited the specialistical, dermatological practice, as the mentioned report states (C: the committee report).
The original author points in this situation to the fact that according to US patent 6858750 (2005) the medical use of fumarate, based on extensive literature study is claimed for the treatment of all possible mitochondrial diseases.
Finally the harmless side effects and the favourable long term effects of fumarates, as shown by Litjens, are strong arguments to use fumarates as a first choice treatment of manifest psoriasis, specifically as dimethylfumarate in slow release form.
A solid medical supervision with the treatment is necessary, that is obvious, but there is no scientifically based reason why this supervision could not be done by a GP.
There is a lot of research literature. I don't have that, but I can give references if necessary.