Mitoxantrone in secondarily progressive multiple sclerosis: a series of 18 patients

Abstract

Mitoxantrone hydrochloride (Novantrone®) is an anthracenedione that has been used as one of the latest in a long line of general immunosuppresive agents studied in multiple sclerosis (MS). We reviewed the clinical, laboratory, neuroimaging and echocardiography data of 18 patients from February 2001 to March 2004 out of a total number of 100 patients with definite MS. Fourteen patients were women (77.7%) and four were men. The mean age of the patients was 41.6±10 years old (confidence intervals 95%: 36.4-46.7 years old). The mean duration of disease was 10.5±6.3 years. Fourteen patients had the secondarily progressive form of MS, and four had the relapsing-remitting form. Mitoxantrone is an useful and clinically effective drug in MS and its major limitation is the potencial cardiotoxicity due to cumulative dose (140 mg).

Early Mitoxantrone-Induced Cardiotoxicity Detected in Secondary Progressive Multiple Sclerosis

“…Interestingly, the other twelve SPMS patients enrolled in the Montu study experienced a decrease in LVEF but MX was not discontinued since this decrease did not yield an LVEF less than 55% in any of these patients. 58 The patients were all monitored by ECHO and were on average younger (mean age = 41.6) than the patients in the current study. The EDSS scores of patients in the Montu study were not indicated.…”

“…The EDSS scores of patients in the Montu study were not indicated. 58 There are a number of factors that may have contributed to the lack of MX efficacy observed in our study. One EDSS-related limitation in this study, as well as other studies, was that all enrolled participants were grouped together regardless of EDSS score (range of 3.5-8).…”

“…However, MX has been used off-label in Canada for SPMS based largely on the results of previous clinical trials in the USA. [56][57][58][59] Several clinical trials examining the efficacy and safety of MX showed promising results for the use of this agent in SPMS. 35,60,61 Several studies have shown that patients treated with MX had an improvement in EDSS score, a decrease in annual relapse rate, as well as a significant decrease in lesions on MRI, among patients treated with of MX versus placebo.…”

“…68 Most of the other studies used ECHO to assess cardiac function in MX treated patients. 58,62,65,69 One study conducted by Rashid et al retrospectively analyzed a subset of patients from the SOLVD study, 70 who either had a MUGA or an ECHO scan. 71 Their analysis provided evidence that ECHO analysis is more subjective, as it depends on the inherent skills of the technician, whereas interpretation of the MUGA is computerized.…”

Role of intraspinal steroid application in patients with multiple sclerosis

“…This confirmed outcomes of previous studies. Here, MIX treatment did not provide a positive impact on MS progression [51,[56][57][58], which in particular appeared in progressive patients with superimposed relapses. Therefore, one can assume that MIX efficacy depends on the number of relapses experience by patients in the year before initiation of MIX treatment [59].…”