Mitoxantrone as rescue therapy in worsening relapsing-remitting MS patients receiving IFN-beta

We assessed the action of mitoxantrone (MX) when given as rescue therapy in patients with relapsing-remitting (RR) multiple sclerosis (MS), whose disease activity worsens despite IFN-beta treatment. Ten very active RR MS patients received MX 12 mg/m2 monthly, for 3 months, and then returned to the original treatment with IFN-beta. Following treatment with MX, 70% of patients were able to return to IFN-beta treatment, stabilising EDSS and relapse rate during a follow-up period of 15-18 additional months. In contrast, in 30% of the patients who were taken off MX and returned to IFN-beta treatment the EDSS score deteriorated and the number of exacerbations increased significantly. The latter patients were switched again to MX treatment at 3-month intervals, stabilising EDSS and relapse rate during 15-18 additional months. Clinical findings correlated with the number of Gd-enhancing lesions disclosed in MRI scans. Immunological data were consistent with the clinical and MRI benefits observed. We conclude that brief courses of MX may provide a safe treatment alternative for RR MS patients who experience rapid and severe worsening of their disease despite IFN-beta treatment.