Multiple Sclerosis (MS) Medications (cont.)
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
In this Article
- Introduction to drugs for the treatment of multiple sclerosis
- What are steroids, and which ones are available?
- What are disease modifying drugs, and which ones are available?
- Avonex (interferon beta-1a)
- Rebif (interferon beta-1a)
- Betaseron and Extavia (interferon beta-1b)
- Copaxone (glatiramer acetate)
- Novantrone (mitoxantrone)
- Tysabri (natalizumab)
- Aubagio (teriflunomide)
- Gilenya (fingolimod)
- Lemtrada (alemtuzumab)
- Plegridy (peginterferon beta-1a)
- Tecfidera (dimethyl fumarate or DMF)
- Ampyra (dalfampridine)
Mitoxantrone or brand name Novantrone is used for reducing neurologic disability and the frequency of acute flare ups in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting MS. Due to risk for cardiac toxicity (heart problems) and limited evidence demonstrating clear benefits, the American Academy of Neurology recommends that use of mitoxantrone be reserved for patient who have rapidly progressing disease and who have failed to respond to other treatment options. Mitoxantrone is a synthetic (man-made) injectable drug that interacts with deoxyribonucleic acid (DNA). It interferes with immune reactions by inhibiting the proliferation or growth of B cells, T cells, and macrophages, all of which are important cells of the immune system. It also impairs the presentation of antigens to cells of the immune system and the secretion of interferon gamma, TNFα and IL-2, chemicals that promote inflammation. The mechanism of action of mitoxantrone in MS is not known but may be related to the modification of the immune system as discussed. In clinical trials, mitoxantrone improved disability, ambulation, frequency of relapse, and neurologic status better than placebo. Mitoxantrone is administered as an intravenous infusion dosed at 12 mg/m2 every 3 months. As mitoxantrone may have toxic effects on the heart, it is not recommended for use in patients with left ventricular ejection fraction (LVEF) <50%, patients with clinically significant reduction in LVEF, or in those who have received a cumulative lifetime dose of mitoxantrone of 140 mg/m2. Furthermore, mitoxantrone should not be administered to patients with white blood cell counts less than 1500 cells/mm3, abnormal liver tests, or who are pregnant.
Side effects of treatment include nausea, hair thinning, loss of menstrual periods, bladder infections, and mouth sores. Heart failure and drops in white blood cell or platelet counts may also occur. Low white blood cell counts may lead to infections while low platelets may cause bleeding. Mitoxantrone is dark blue in color and may turn the urine or the sclera of the eyes a blue-green color. Mitoxantrone was approved by the FDA to treat RRMS or secondary progressive MS in October 2000. Mitoxantrone is also approved to treat various types of cancers or tumors, and has been used medically since 1987. Mitoxantrone is classified as FDA pregnancy category D and should not be used during pregnancy as it may cause harm to the unborn fetus. Females who may become pregnant must be made aware of the risk and use appropriate forms of birth control (contraception). Females who are of childbearing potential should have a pregnancy test prior to each dose of mitoxantrone.
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