Mitoxantrone-induced cardiotoxicity in patients with multiple sclerosis

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Limited treatment options exist for secondary progressive and worsening relapsing-remitting multiple sclerosis (MS).
• Mitoxantrone, an antineoplastic agent, is approved for MS treatment but carries a risk of dose-related cardiotoxicity.
• This cardiotoxicity can restrict the clinical utility of mitoxantrone in managing MS.

Purpose of the Study:

• To investigate the potential cardiotoxicity associated with mitoxantrone therapy in multiple sclerosis patients.
• To evaluate cardiac function in MS patients undergoing mitoxantrone treatment over a one-year period.

Main Methods:

• A cohort of 96 patients with worsening relapsing-remitting or secondary progressive MS was studied.
• Cardiac assessments, including electrocardiogram and echocardiography, were performed at baseline and at 6 and 12 months.
• Patients received mitoxantrone at a dose of 12 mg/m², with analysis focused on those receiving at least 4 doses.

Main Results:

• No clinically significant cardiac dysfunction was observed in the 96 patients over 12 months.
• Three patients experienced a decrease in left ventricular ejection fraction (LVEF) of <10% from baseline.
• Three patients had an LVEF below 50%.

Conclusions:

• Mitoxantrone (12 mg/m²) is an effective and generally well-tolerated treatment for progressive MS.
• The risk of developing cardiotoxicity appears low in multiple sclerosis patients within one year of mitoxantrone therapy.
• Mitoxantrone can be considered a viable option for managing specific MS subtypes, with careful cardiac monitoring.