Study of mitoxantrone for the treatment of recurrent neuromyelitis optica (Devic disease).
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.
Weinstock-Guttman
Bianca
B
The William C. Baird Multiple Sclerosis Center, Jacobs Neurological Institute, State University of New York, Buffalo, NY 14203, USA. BGuttman@TheJNI.org
Ramanathan
Murali
M
Lincoff
Norah
N
Napoli
Salvatore Q
SQ
Sharma
Jitendra
J
Feichter
Joan
J
Bakshi
Rohit
R
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
D000970:Antineoplastic Agents; D008942:Mitoxantrone