How It Works
Mitoxantrone is an
immunosuppressant, a type of medicine that reduces the activity of the
immune system. It has been used to treat
leukemia and some advanced prostate cancer. Multiple sclerosis (MS) appears to be a disease in
which the immune system attacks the covering of the nerves (myelin sheath)
within the brain and spinal cord, so immunosuppressants may slow the progression
of the disease. Immunosuppressants other than mitoxantrone, though, have not
been shown to significantly reduce the progression of MS or the frequency of
Mitoxantrone may be injected once every 3 months for up to 3 years.
A higher total dose increases the risk of serious heart damage.
Why It Is Used
Mitoxantrone is used to treat several forms of advancing MS, including
secondary progressive MS,
progressive relapsing MS, and advanced
Mitoxantrone is one of only two
medicines that have been shown to benefit people who have secondary progressive
MS that is relapsing. The interferon beta medicine Betaseron is the other.
Interferon beta will likely remain the first choice for treating secondary
progressive MS, because it does not carry the risk of heart damage associated
with mitoxantrone. Mitoxantrone may be
tried if you develop severe side effects from interferon beta, cannot take the
medicine for some other reason, or continue to have active disease.
How Well It Works
Mitoxantrone reduces the frequency of relapses and helps slow the
development of disability in people who have secondary progressive MS that is
relapsing or advanced relapsing-remitting MS. Some studies have shown that
when mitoxantrone is combined with other drugs such as intravenous
methylprednisolone (IVMP) or interferon beta, the rate of new MS lesions in the brain
has been reduced.1
Use of mitoxantrone may cause serious, even fatal, heart damage in
some people. It also can cause
bone marrow problems. Frequent tests, including a
heart scan, are recommended before each injection of this medicine. To reduce
the risk of heart damage associated with the medicine, you should receive
only a limited number of doses. The U.S. Food and Drug Administration (FDA) recommends up to 12 total doses.
Typically, the medicine is injected once every 3 months for 2 to 3
Common but less serious side effects of mitoxantrone
- Increased risk of infections, especially urinary tract
- Changes in a woman's menstrual cycle.
Diarrhea or constipation.
See Drug Reference for a full list of side effects. (Drug Reference
is not available in all systems.)
What To Think About
Due to safety concerns and the limitations on its use, mitoxantrone
is for the most part being used only in specialized MS clinics or centers
staffed by neurologists and other health professionals who specialize in
treating people with MS.
As with interferon beta, people who are taking mitoxantrone need to
have regular blood tests to monitor white and red blood cell counts and liver
function. These are in addition to the regular testing needed to monitor heart
function. Mitoxantrone is not recommended for people who already have heart
disease, liver problems, or certain blood disorders, because it may make these
Mitoxantrone should not be used during pregnancy. Women taking
mitoxantrone should use a reliable form of birth control if there is any chance
they could become pregnant. If you become pregnant while you are taking this
medicine or are thinking about trying to become pregnant, contact your doctor
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Stuart WH, Vermersch P (2004). Concomitant therapy for
multiple sclerosis. Neurology, 63(Suppl 5):