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More MS news articles for October 2002

Mitoxantrone Monotherapy Associated With Low Incidence of Congestive Heart Failure in Multiple Sclerosis

By Mark Greener

A DGReview of :"Cardiac adverse effects associated with mitoxantrone (Novantrone) therapy in patients with MS."

Mitoxantrone monotherapy is associated with a low incidence of congestive heart failure in multiple sclerosis patients.

Researchers from Immunex Corp reviewed the records of 1378 patients enrolled in three clinical studies assessing mitoxantrone in multiple sclerosis. The median follow up was 29 months. None of the patients showed congestive heart failure before treatment. The authors reported that 779 patients completed testing for left ventricular ejection fraction (LVEF). At baseline, all patients showed LVEF of at least 50 per cent.

The mean cumulative mitoxantrone dose was 60.5 mg/m2, although this ranged from 2 to 183 mg/m2. Furthermore, 141 patients received a cumulative mitoxantrone dose of at least 100 mg/m2.

Mitoxantrone can cause dose-related cardiotoxicity when given concurrently with other cytotoxic agents. In this study, two patients developed congestive heart failure following mitoxantrone monotherapy. Furthermore, 17 patients developed asymptomatic LVEF of <50%, equivalent to an incidence of 2.18 per cent. The authors identified a non-significant trend towards a higher risk of asymptomatic LVEF at cumulative doses of 100 mg/m2 or more compared to lower doses: 5 and 1.8 per cent respectively. Dosing schedule, duration of therapy, age, and gender were not associated with LVEF.

The authors concluded that mitoxantrone at a mean cumulative dose of 60.5 mg/m2 was associated with an incidence of congestive heart failure of less than 0.2 per cent in patients with multiple sclerosis. Nevertheless, they advocated continuing monitoring to determine whether congestive heart failure becomes more common with either higher doses or longer follow-up.

Neurology 2002;59:909-13. "Cardiac adverse effects associated with mitoxantrone (Novantrone) therapy in patients with MS."

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