DOI: https://doi.org/10.22141/2224-0713.7.77.2015.78129

Efficiency of Mitoxantrone in Patients with Progressive Forms of Multiple Sclerosis

V.V. Vasylovskyi, N.P. Voloshyna, T.V. Nehreba, M.Ye. Chernenko

Abstract


We have examined the efficacy, safety and tolerability of mitoxantrone in 67 patients with progressive forms of multiple sclerosis (MS).
There was carried out the analysis of clinical and radiological fin-dings in 19 patients with primary progressive (PP) and in 48 patients with secondary progressive (SP) MS treated with second-line cytostatic — mitoxantrone. Evaluation of clinical and radiological activity of the disease, based on the treatment outcomes, was performed immediately after the course of mitoxantrone administration and annually for 2 years after its completion. The following parameters were taking into account: the dynamics of the severity of neurological deficit according to the data of EDSS, the presence and duration of stabilization phase, the rates and variants of further progression, the nature of prognosis, the number of gadolinium-enhanced lesions according to the MRI findings. Considering these indicators, there have been developed the criteria of high, moderate and low effectiveness of treatment.
By the end of mitoxantrone administration, the high efficiency of treatment, in the form of partial regression of neurological deficit on the background of stabilization phase, was obtained in 25 % of patients with SPMS and in 21.1 % — with PPMS, in uncertain nature of prognosis; the moderate efficiency as sustained stabilization also prevailed in patients with uncertain prognosis — in 50.0 % with SP and in 36.8 % with PP; low efficiency, in the form of decrease in steady progression and its transformation into more favorable progressive variant, was determined in 22.9 % of patients with SP and in 26.3 % of patients with PP in unfavorable prognosis.
By the end of the two-year follow-up, a positive therapeutic effect of mitoxantrone with high to moderate efficacy was maintained in 50.0 % of patients with SP and in 42.1 % — with moderate efficacy in PP. During this period, the negative dynamics with the selective reorganization of success rates was obtained in 20 (41.6 %) patients with for SP and in 11 (57.9 %) — with PPMS.
Mitoxantrone, according to the MRI monitoring, slows the radiological activity of inflammatory process, reduces the number of new confirmed gadolinium-enhanced lesions, but has no effect on the overall neurodegenerative process that depends on the duration, severity and type of MS with prevalence in PP.
Conclusion. There has been proved the clinical and radiological efficacy of cytostatic mitoxantrone as a method of de-escalation immunosuppressive therapy in severe, almost incurable progressive forms of MS, considering the course, nature of prognosis, severity of neurological deficit, rates and variants of progression.


Keywords


multiple sclerosis; mitoxantrone; efficacy of treatment; clinical and radiological activity of disease

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