A to Z of MS Mitoxantrone

Product names

Novantrone (USA)

Mitoxantrone is a form of chemotherapy that is occasionally used in some specialist multiple sclerosis centres to treat aggressive forms of relapsing remitting MS or in the early stages of secondary progressive MS where relapses are still a significant feature.

Mitoxantrone might be used for someone who experiences very frequent and severe relapses that leave residual disability, or it may be used for people who have not responded to either beta interferon or glatiramer acetate. It might also be used to stabilise someone with severe, frequent relapses so that they can subsequently start on beta interferon or glatiramer acetate.

There is no robust evidence to support the use of mitoxantrone in primary progressive MS, or in the later stages of secondary progressive MS (EDSS > 6.0)

How is mitoxantrone given?

Mitoxantrone is given by intravenous infusion in hospital, often on a day patient basis.

How mitoxantrone works

Mitoxantrone appears to work by suppressing the body's immune system for the period of treatment, depleting the number of cells that are attacking the myelin around nerves. This effectively gives the body a chance to 'restart' and sort out what has gone wrong with the immune system.

Side effects and contraindications

Many people experience some, or all, of these common side effects:

• changes in menstruation pattern and/or temporary cessation of periods, in some women this can be permanent
• nausea
• temporary hair thinning (in common with other anti-cancer drugs)
• blue-green urine for 24 hours after infusion.

Mitoxantrone may damage the heart, and can cause congestive heart disease if taken over a long period of time. To reduce this risk, the total amount any one person may take in their lifetime is limited to between 8-12 doses. Treatment with mitoxantrone can cause some people to develop leukaemia.

Mitoxantrone may cause birth defects if either parent is receiving it when a baby is conceived, so effective contraception should be used whilst on treatment and for up to six months after treatment stops. Mitoxantrone may be passed on through breast milk, so should not be taken whilst a woman is breastfeeding.

References

Millefiorini E, et al.
Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome.
Journal of Neurology 1997; 244(3): 153-159.
abstract

Edan G, et al.
Rationale for the use of mitoxantrone in multiple sclerosis.
Journal of the Neurological Sciences 2004; 223: 35-39.
abstract

Marriott J, et al.
Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
Neurology 2010;74(18):1463-1470.
abstract

Patient Information Leaflets

Mitoxantrone (EMC website)

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