Mitoxantrone as induction treatment in aggressive relapsing remitting multiple sclerosis: treatment response factors in a 5 year follow-up observational study of 100 consecutive patients

Le Page, Emmanuelle; Leray, Emmanuelle; Taurin, Grégory; Coustans, Marc; Chaperon, Jacques; Morrissey, Sean P.; Edan, Gilles
January 2008
Journal of Neurology, Neurosurgery & Psychiatry;Jan2008, Vol. 79 Issue 1, p52
Academic Journal
Background: Mitoxantrone was approved by the French health authority (AFSAPPS) in October 2003 to treat patients with aggressive multiple sclerosis (MS). Objective: To report the long term effectiveness and safety of mitoxantrone as induction therapy in patients with aggressive relapsing-remitting MS, and to assess treatment response factors. Material and methods: 100 consecutive patients with aggressive relapsing—remitting MS received mitoxantrone 20 mg monthly combined with methylprednisolone 1 g for 6 months. Relapses, Expanded Disability Status Scale (EDSS) and drug safety were assessed every 6 months for up to at least 5 years. Within 6 months after induction, 73 patients received maintenance therapy (mitoxantrone every 3 months (n = 21); interferon beta (n = 25); azathioprine (n = 15); methotrexate (n = 7); glatiramer acetate (n = 5)). Results: During the 12 months following initiation of mitoxantrone, the annual relapse rate (ARR) was reduced by 91%, 78% of patients remained relapse free, MRI activity was reduced by 89%, the mean EDSS decreased by 1.2 points (p<10-6) and 64% of patients improved by 1 point or more on the EDSS. In the longer term, the ARR reduction was sustained (0.29-0.42 for up to 5 years), the median time to the first relapse was 2.8 years and disability remained improved after 5 years. Younger age and lower EDSS score at the start of mitoxantrone treatment were predictive of better treatment response. Three patients presented with an asymptomatic decrease in left ventricular ejection fraction to less than 50% (one reversible). One patient was diagnosed with acute myeloid leukaemia (remission 5 years after diagnosis). Conclusion: Mitoxantrone monthly for 6 months as induction therapy followed by maintenance treatment showed sustained clinical benefit for up to 5 years with an acceptable adverse events profile in patients with aggressive relapsing—remitting MS.


Related Articles


    Focuses on the treatment of relapsing remitting multiple sclerosis in the U.S. Goals of multiple sclerosis treatment; Decrease in the inflammation in the central nervous system after interferon administration; Safety of interferon.

  • Managing the Adverse Effects of Interferon-β Therapy in Multiple Sclerosis. Bayas, A.; Rieckmann, P. // Drug Safety;Feb2000, Vol. 22 Issue 2, p149 

    Interferon-β is an established therapy in relapsing-remitting multiple sclerosis. Recently, it has also been shown that interferon-β-1b is effective in secondary progressive multiple sclerosis. However, adverse effects of interferon-β treatment are common, particularly during the first...

  • Highly Active Antiretroviral Therapy: Current State of the Art, New Agents and Their Pharmacological Interactions Useful for Improving Therapeutic Outcome. Barbaro, Giuseppe; Scozzafava, Andrea; Mastrolorenzo, Antonio; Supuran, Claudiu T. // Current Pharmaceutical Design;May2005, Vol. 11 Issue 14, p1805 

    Highly active antiretroviral therapy (HAART) dramatically changed the course of HIV infection. Currently, this therapy involves the use of agents from at least two distinct classes of antivirals: a protease inhibitor (PI) in combination with two nucleoside/nucleotide reverse transcriptase...

  • antiviral (Major drug group).  // Royal Society of Medicine: Medicines;2002, p82 

    The article presents information on antiviral drugs. These drugs are used to treat infections caused by viruses. Mainly, the use of antivirals is restricted to preventive or disease-limitation treatment. However, some antiviral drugs can be life-savers, especially in immunocompromised patients....

  • valacyclovir.  // Davis's Drug Guide for Nurses, 9th edition;2005, p1063 

    Provides information on the antiviral drug valacyclovir. Therapeutic indications; Mechanism of action; Pharmacokinetic characteristics; Contraindications and precautions; Adverse reactions and side effects.

  • Improving adherence to antiretroviral therapy. Nischal, K. C.; Khopkar, Uday; Saple, D. G. // Indian Journal of Dermatology, Venereology & Leprology;Sep/Oct2005, Vol. 71 Issue 5, p316 

    Antiretroviral therapy (ART) has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral...

  • Treatment of adenovirus infections in the immunocompromised host. Ljungman, P. // European Journal of Clinical Microbiology & Infectious Diseases;Aug2004, Vol. 23 Issue 8, p583 

    Adenovirus infections are increasing as causes of morbidity and mortality in severely immunocompromised patients. The currently available antiviral agents, ribavirin and cidofovir, have yielded mixed results in case reports and small case series. Similar to cytomegalovirus disease, established...

  • Atazanavir: A Review of its Use in the Management of HIV Infection. Tracy Swainston Harrison; Scott, Lesley J. // Drugs;2005, Vol. 65 Issue 16, p2309 

    Atazanavir (Reyataz®) is a novel protease inhibitor (PI) approved for use in combination with other antiretroviral drugs for the treatment of HIV infection. In antiretroviral therapy (ART)-experienced patients the drug is administered with low-dose ritonavir (i.e. boosted). In the US,...

  • The efficacy of natalizumab in patients with relapsing multiple sclerosis: subgroup analyses of AFFIRM and SENTINEL. Hutchinson, Michael; Kappos, Ludwig; Calabresi, Peter A.; Confavreux, Christian; Giovannoni, Gavin; Galetta, Steven L.; Havrdova, Eva; Lublin, Fred D.; Miller, David H.; O'Connor, Paul W.; Phillips, J. Theodore; Polman, Chris H.; Radue, Ernst-Wilhelm; Rudick, Richard A.; Stuart, William H.; Wajgt, Andrzej; Weinstock-Guttman, Bianca; Wynn, Daniel R.; Lynn, Frances; Panzara, Michael A. // Journal of Neurology;Mar2009, Vol. 256 Issue 3, p405 

    The AFFIRM and SENTINEL studies showed that natalizumab was effective both as monotherapy and in combination with interferon beta (IFNβ)-1a in patients with relapsing multiple sclerosis (MS). Further analyses of AFFIRM and SENTINEL data were conducted to determine the efficacy of natalizumab...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics