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Severe delayed heart failure in three multiple sclerosis patients previously treated with mitoxantrone
Sophie Goffette1, Vincent van Pesch, Jean Louis Vanoverschelde
1Service de Neurologie, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium. sophie.goffette@nchm.ucl.ac.be
Journal of Neurology
|April 19, 2005
Summary
Mitoxantrone can treat multiple sclerosis (MS) but may cause delayed heart failure months after treatment. Long-term monitoring of MS patients receiving mitoxantrone is essential for detecting potential cardiac issues.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Mitoxantrone is an approved treatment for worsening relapsing-remitting, secondary progressive, and progressive relapsing multiple sclerosis (MS).
- This study evaluated the cardiac safety of mitoxantrone in a cohort of 820 MS patients, with 52 receiving the drug between 1991 and 2003.
Observation:
- Mitoxantrone was administered at 12 mg/m(2) monthly for three months, then quarterly to a cumulative dose of 144 mg/m(2).
- Left ventricular ejection fraction (LVEF) was monitored via radionuclide ventriculography every six months; treatment ceased if LVEF fell below 50% in two consecutive tests.
- No cardiotoxicity was observed during treatment, but three patients developed congestive heart failure 24, 39, and 80 months post-treatment.
Findings:
- Two of the three patients who developed heart failure had prior cyclophosphamide treatment.
- While initial recovery occurred with medical treatment, two patients relapsed, and one remained severely symptomatic.
Implications:
- Despite mitoxantrone's efficacy in reducing MS progression and exacerbations, delayed cardiotoxicity necessitates long-term cardiac monitoring in MS patients.
- This finding highlights the importance of ongoing surveillance for adverse cardiac events even after mitoxantrone therapy cessation.