Mitoxantrone for multiple sclerosis
Examples
Generic Name mitoxantrone Mitoxantrone is not officially approved (labelled or indicated) for MS treatment in Canada. However, it is an approved medication, and some clinics and neurologists are using the medication for people whose MS is rapidly progressing or who have not responded well to other therapies (an unlabelled use).1
How It Works
Mitoxantrone is an immunosuppressant, a type of medication that reduces the activity of the immune system. It has been used to treat leukemia and some advanced prostate cancer. Since multiple sclerosis (MS) appears to be a disease in which the immune system attacks the covering of the nerves (myelin sheath) within the brain and spinal cord, immunosuppressants may slow the progression of the disease. Immunosuppressants other than mitoxantrone, however, have not been shown to significantly reduce the progression of MS or the frequency of relapses.
Mitoxantrone may be injected once every 3 months for up to 3 years. A higher total dose increases the risk of serious heart damage.
Why It Is Used
Mitoxantrone is not officially approved for MS treatment in Canada, but it is used in both Canada and the United States for treatment of several forms of advancing MS, including secondary progressive MS, progressive relapsing MS, and advanced relapsing-remitting MS.
Mitoxantrone is one of only two medications that have been shown to benefit people with secondary progressive MS that is relapsing; the interferon beta medication Betaseron is the other. Betaseron will likely remain the first choice for treating secondary progressive MS because it does not carry the risk of heart damage associated with mitoxantrone. Mitoxantrone may be tried if you develop severe side effects from Betaseron, cannot take the medication for some other reason, or continue to have active disease.
How Well It Works
Mitoxantrone reduces the frequency of relapses and helps slow the development of disability in people with secondary progressive MS that is relapsing, or advanced relapsing-remitting MS. Some studies have shown that when mitoxantrone is combined with other drugs such as intravenous methylprednisolone (IVMP) or Betaseron, the rate of new MS lesions in the brain has been reduced.2
Side Effects
Use of mitoxantrone may cause serious, even fatal, heart damage in some people. It also can cause bone marrow problems. Frequent tests, including a heart scan, are recommended before each injection of this medication. To reduce the risk of heart damage associated with the medication, you should receive only a limited number of doses—the Multiple Sclerosis Society of Canada and the U.S. FDA recommend up to 12 total doses. Typically, the medication is injected once every 3 months for 2 to 3 years.
Common but less serious side effects of mitoxantrone include:
- Nausea.
- Hair loss.
- Increased risk of infections, especially urinary tract infections.
- Changes in a woman's menstrual cycle.
- Mouth sores.
- Diarrhea or constipation.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Due to safety concerns and the limitations on its use, mitoxantrone is for the most part being used only in specialized MS clinics or centres staffed by neurologists and other health professionals who specialize in treating people with MS.
As with interferon beta, people who are taking mitoxantrone need to have regular blood tests to monitor white and red blood cell counts and liver function. These are in addition to the regular testing needed to monitor heart function. Mitoxantrone is not recommended for people who already have heart disease, liver problems, or certain blood disorders because it may make these problems worse.
Mitoxantrone should not be used during pregnancy. Women taking mitoxantrone should use a reliable form of birth control if there is any chance they could become pregnant. If you become pregnant while you are taking this medication or are thinking about trying to become pregnant, contact your doctor immediately.
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| Author: | Douglas Dana Shannon Erstad, MBA/MPH | Last Updated: August 14, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Colin Chalk, MD, CM, FRCPC - Neurology Barrie J. Hurwitz, MD - Neurology | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |