title: Efficacy of mitoxantrone in neuromyelitis optica spectrum: clinical and neuroradiological study.
abstract: OBJECTIVE
  To evaluate the efficacy of mitoxantrone (MTX) on clinical and neuroradiological parameters of patients who had a relapse of neuromyelitis optica spectrum (NMOS) within the 12 previous months.
  
  
  METHODS
  MTX (12 mg/m(2)) combined with methylprednisolone 1 g as three monthly courses followed by three quarterly courses was administered during an observational multicentre open study including 51 consecutive patients (28 NMO, 23 limited forms of NMO) of the French Caribbean and Guyana. The main outcome measure was the reduction of the annualised relapse rate (ARR), and the secondary outcome measures were alteration of disability measured by expanded disability status scale (EDSS) score, the time to onset of the first relapse, and the progression of neuroradiological lesions at 1 year of treatment.
  
  
  RESULTS
  At 1 year of treatment, the ARR dropped from 1.82 to 0.37 (p<0.0001). The mean EDSS score improved by 1.3 points, going from 5.8 at baseline to 4.5 at 1 year (p<0.0001). The number of patients showing gadolinium (Gad)+ spinal cord lesions at baseline, that is, 46.9%, dropped to 10.6% (a 77.4% reduction; p=0.02). The median time to onset of the first relapse was 18 months. IgG-NMO seropositivity was a predictive factor of relapse (p=0.006). A case of acute myeloid leukaemia was observed after a mean time span of 4.8 years.
  
  
  CONCLUSIONS
  In this observational NMO study, MTX decreased dramatically the frequency of relapses, which is directly related to progression of disability or even death in this disorder.
authors.affiliation: Department of Neurology, CHRU Pierre Zobda-Quitman, Fort de France, Martinique 97261, French West Indies. pcabre_fr@yahoo.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Cabre
authors.forename: Stephane
authors.initials: S
authors.lastname: Olindo
authors.forename: Romain
authors.initials: R
authors.lastname: Marignier
authors.forename: Severine
authors.initials: S
authors.lastname: Jeannin
authors.forename: Harold
authors.initials: H
authors.lastname: Merle
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use*; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D013116:Spinal Cord / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D007074:Immunoglobulin G; D008942:Mitoxantrone; D008775:Methylprednisolone