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Evidence summaries

Mitoxantrone for Multiple Sclerosis

Mitoxantrone may be efficient in reducing the risk of progression and the frequency of relapses in patients with relapsing-remitting or secondary progressive multiple sclerosis (MS) in a short-term follow-up (two years). Level of evidence: "C"

A Cochrane review [Abstract] 1 included 3 studies with a total of 221 subjects. The patients had either relapsing remitting or secondary progressive MS. Different mitoxantrone dosages and time schedules were used in the studies. Mitoxantrone reduced the progression of disability at 2 years follow-up (proportion of participants with 6-months confirmed progression of disability (OR 0.30, 95% CI 0.09 to 0.99; one trial, n=128 and MD -0.36, 95% CI- 0.70 to -0.02; p = 0.04; 2 trials, n=175). Significant results were found regarding the reduction in annualised relapse rate (MD -0.85, 95% CI -1.47 to -0.23; p = 0.007; 2 trials, n=206), the proportion of patients free from relapses at one year (OR 7.13, 95% CI 2.06 to 24.61; p = 0.002; one trial, n=51) and two years (OR 2.82, 95% CI 1.54 to 5.19; p = 0.0008; 2 trials, n=179), and the number of patients with active MRI lesions at 6 months or one year only (OR 0.24, 95% CI 0.10 to 0.57; p = 0.001; 3 trials, n=132). Side effects reported in the trials (amenorrhoea, nausea and vomiting, alopecia and urinary tract infections) were more frequent in treated patients than in controls, while no major adverse events have been reported.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and inconsistency (heterogeneity in patients and interventions).

    References

    • Martinelli Boneschi F, Vacchi L, Rovaris M et al. Mitoxantrone for multiple sclerosis. Cochrane Database Syst Rev 2013;5():CD002127. [PubMed].

Primary/Secondary Keywords