Regular dose (240 mg) - Started

Yesterday, I upped my dose of Tecfidera and started taking the regular dose (240mg). Since the starter pack contains 56 pills of 120mg, I’m simply taking two pills instead of one until I go through them. The pharmacist told me that the following packs will have 240mg pills.

So far so good! No side effects after three. Still not claiming victory as I don’t want to jinx it and side effects are not ruled out in a few days. But, things are looking good so far.

Looking at the Tecfidera prescription information, the table below describes the incidence of each side effect. It shows that things are not as bad as it seems, especially when reading forums. It's normal that people that are having side effects tend to go on the forums much more often than people that don't.

Unfortunately, if you read the data above, you can't draw conclusions at the number of people that had no side effects as the types are independent. What I mean, is that you can’t add the numbers together. 

The most obvious example is that a person experiencing vomiting is likely to also experience nausea. Here 12% of patients in the study experienced nausea, and 9% experienced vomiting. I would be that almost all patients that vomited also had nausea. The same goes, maybe to a lesser extent, with other GI issues. Now, how independent are GI issues from flushing, the most frequent side effect? Now, if both side effects, GI issues and flusing, were completely independent, i.e. having one doesn’t up the chances of having the other, to find how many unlucky patients had both GI issues and flushing, you need to multiply the percentages. Here, I’ll assume GI issues are pretty dependent and guess 20% of patients had some GI issue. 

So the percentage of patients having both is 20% x 40% = 8%. This means that 32% only had flushing, 12% only had GI issues. Which brings the proportion of patients that had none of the two side effects to 48%. As for the other side effects registered, they’re mostly skin issues that I would guess affect the people that experienced flushing. 48% had no side effects, see it as you wish, the glass is half full or half empty.

Furthermore, with the same kind of estimates and statistical evaluation, 17% of patients taking the placebo have experienced some of the side effects listed! These are unrelated to the Tecfidera administration, obviously. So the glass is even fuller! You're 35% more likely to experience some side effect if you're on Tecfidera than if you're not. This added to the fact that most side effect, while on Tecfidera, seem to reduce over time and sometimes disappear, no wonder it's been judged by an external review as the drug with the least side effects.