Efficacy in Clinical Practice of Mitoxantrone for Worsening MS.
|Title||Efficacy in Clinical Practice of Mitoxantrone for Worsening MS.|
|Publication Type||Journal Article|
|Authors||Wundes A, Kraft GH, Bowen JD, Gooley TA, Nash RA|
|Journal||International Journal of MS Care|
Background: Mitoxantrone has been approved by the US Food and Drug Administration for worsening multiple sclerosis (MS), and its efficacy has been demonstrated in clinical trials. In clinical practice, however, patients may receive less than the full dose because of patients’ ambivalence, history of noncompliance, or intolerance of the drug. We studied efficacy of mitoxantrone for worsening disease in a clinical setting in an academic multidisciplinary MS center. Methods: One hundred three MS patients from the Western MS Center at the University of Washington who were prescribed mitoxantrone for worsening disease between September 1999 and February 2005 were studied retrospectively by medical chart review. Data collection included information on disease, such as type of MS, relapse history, and Expanded Disability Status Scale (EDSS), in relation to mitoxantrone treatment history. Results: To date, data from 62 patients have been analyzed. Most of these patients had either secondary progressive MS (n = 30) or relapsing-remitting MS (n = 23). Twenty-one had completed at least 2 years of mitoxantrone administration, whereas 41 discontinued infusions prematurely. Patients received a mean of 5.6 infusions (median 5). The mean EDSS score at initiation of mitoxantrone was 6.36. At discontinuation, patients had worsened by an average of 0.24 points on EDSS (P = .04). Twen-ty percent of patients showed improvement, 45% remained stable, and 34% declined based on EDSS. The number of relapses decreased during (–0.66, P = .005) and after (– 0.85, P = .0003) treatment compared with the relapses reported within the 2 years before initiation of mitoxantrone. Two patients converted from relapsing-remitting MS to secondary progressive MS during mitoxantrone treatment; both received only a few infusions with some delays. Conclusions: Our data suggested that mitoxantrone stabilized disease activity in patients with worsening MS treated in a clinical setting. Despite frequent suboptimal conditions and incomplete treatment schedules, patients showed relatively stable neurological functioning and a fewer relapses.