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Diroximel fumarate is an oral small molecule drug used to treat relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. It acts as an immunosuppressant and anti-inflammatory agent by activating the Nrf2 pathway, which decreases inflammation and helps prevent nerve damage associated with MS. Diroximel fumarate is structurally related to dimethyl fumarate but was developed to reduce gastrointestinal side effects. The drug was formulated by Alkermes in collaboration with Biogen and approved for use in the United States in October 2019 and in the European Union in November 2021[1][2][3][4][5].
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