Mitoxantrone for worsening MS: compliance problems in clinical practice.
|Title||Mitoxantrone for worsening MS: compliance problems in clinical practice.|
|Publication Type||Journal Article|
|Authors||Wundes A, Kraft GH, Bowen JD, Gooley TA, Nash RA|
|Journal||International Journal of MS Care|
Background: Management of worsening multiple sclerosis (MS) continues to pose a major therapeutic challenge because of limited treatment options. Available treatments are associated with significant risks. We review our experience with mitoxantrone for worsening MS, including compliance and tolerability for patients treated at an academic multidisciplinary MS center. Methods: One hundred three MS patients from the Western MS Center at University of Washington who were prescribed mitoxantrone for worsening disease between September 1999 and February 2005 were studied retrospectively by medical chart review. In addition to demographics and clinical efficacy, data on mitoxantrone treatment history and side effects, including hematological and cardiac toxicity, were collected. Results: To date, data from 63 patients have been analyzed. Most of these patients had either secondary progressive MS (n = 30) or relapsingremitting MS (n = 24). Twenty-two had completed at least 2 years of administration or received the US Food and Drug Administration’s recommended maximal allowable dose of 140 mg/m2. Forty-one patients discontinued infusions prematurely, predominantly at their own request (n = 13) or because of intolerable side effects (n = 8). Among patients analyzed, there were four with decrease of left ventricular ejection fraction to <50% and one case of discontinuation because of thrombocytopenia. In 10 patients, the dosage was reduced to <12 mg/m2 at least once because of poor tolerability (n = 7), preinfusion leukopenia (n = 2), or unknown reason (n = 1). Two patients were treated throughout on a reduced dose schedule because of preexisting thrombocytopenia (n = 1) or add-on therapy to interferon (n = 1). Conclusions: This experience identified that as many as two thirds of patients enrolled on mitoxantrone did not receive the intended cumulative dose; they stopped prematurely because of disillusionment or adverse events. However, only a few patients had to discontinue treatment for objective safety reasons. Our data offer relevant insights into challenges of tolerability and compliance in the use of mitoxantrone in clinical practice.