title: Study of mitoxantrone for the treatment of recurrent neuromyelitis optica (Devic disease).
abstract: BACKGROUND
  Neuromyelitis optica is a severe demyelinating disease that selectively involves the optic nerves and the spinal cord but usually spares the brain. It is considered to have a B-cell-induced pathogenesis. Mitoxantrone hydrochloride, a synthetic anthracenedione approved for worsening relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis, has been shown to primarily suppress the humoral response.
  
  
  OBJECTIVE
  To evaluate the benefit of mitoxantrone treatment in patients with relapsing neuromyelitis optica.
  
  
  METHODS
  Prospective 2-year study.
  
  
  METHODS
  Academic multiple sclerosis center.
  
  
  METHODS
  Five patients (3 women and 2 men) with an age range of 20 to 51 years and an Expanded Disability Status Scale score of 2.5 to 6.5 (mean +/- SD, 4.40 +/- 1.88).
  
  
  METHODS
  Monthly intravenous infusions of mitoxantrone hydrochloride, 12 mg/m2, for 6 months followed by 3 additional treatments every 3 months.
  
  
  METHODS
  Expanded Disability Status Scale score measured every 3 months and during relapses; findings on orbital, brain, and spinal cord magnetic resonance images performed at baseline and at 3, 6, 12, 18, and 24 months; and visual evoked potentials and results of ophthalmologic evaluations performed at baseline and annually.
  
  
  RESULTS
  During the 2 years of treatment, 2 patients each had a relapse once within the initial 5 months of treatment (1 severe and 1 moderate). Improvement was seen clinically and on magnetic resonance images in 4 patients. Patients generally tolerated the treatment well, although 1 patient had a reversible decrease in cardiac ejection fraction.
  
  
  CONCLUSIONS
  Our results suggest a beneficial effect of mitoxantrone treatment for relapsing neuromyelitis optica.
authors.affiliation: The William C. Baird Multiple Sclerosis Center, Jacobs Neurological Institute, State University of New York, Buffalo, NY 14203, USA. BGuttman@TheJNI.org
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Murali
authors.initials: M
authors.lastname: Ramanathan
authors.forename: Norah
authors.initials: N
authors.lastname: Lincoff
authors.forename: Salvatore Q
authors.initials: SQ
authors.lastname: Napoli
authors.forename: Jitendra
authors.initials: J
authors.lastname: Sharma
authors.forename: Joan
authors.initials: J
authors.lastname: Feichter
authors.forename: Rohit
authors.initials: R
authors.lastname: Bakshi
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002490:Central Nervous System / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage* / Q000009:adverse effects; D009471:Neuromyelitis Optica / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D008942:Mitoxantrone