Mitoxantrone Useful for Recurrent NMO

Mitoxantrone (Novantrone) may benefit patients with recurrent neuromyelitis optica (NMO) also known as Devic disease, an inflammatory disorder that strikes the optic nerves and spinal cord. A team led by Bianca Weinstock-Guttman, MD, associate professor of neurology at University at Buffalo, State University of New York, and director of the William C. Baird Multiple Sclerosis Center at Buffalo General Hospital, studied 5 patients who were given monthly intravenous infusions of mitoxantrone, 12 mg/m², for 6 months followed by 3 additional treatments every 3 months.

During the 2 years of treatment, 2 patients relapsed once within the initial 5 months of treatment (1 severe and 1 moderate). Four of 5 patients demonstrated clinical improvement and improvement on MRI. "I have since treated an additional 2 patients with a similar protocol and have had great results," Weinstock-Guttman told Applied Neurology.

These results may provide hope for patients with NMO who are seeking effective treatment. "The small case series of mitoxantrone in NMO is encouraging, given that this form of multiple sclerosis is typically unresponsive to injectible medications-interferons and glatiramer acetate [Copaxone]," said Robert Fox, MD, medical director of the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic.

The design of this study was based on its authors' clinical experience. The protocol was initially designed to provide patients with mitoxantrone at a dosage of 12 mg/m² each month for the first 3 months followed by therapy every 3 months, explained Weinstock-Guttman. However, 2 patients relapsed at 5 months. "Therefore, we changed treatment to 6 monthly pulses of 12 mg/m² followed by 3 additional treatments every 3 months with great benefit."

"Because NMO is considered to be a B-cell-mediated disease, it is pretty clear that mitoxantrone will be one of the more effective treatments for NMO," said Douglas Jeffery, MD, PhD, assistant professor in neurology at Wake Forest University School of Medicine, Winston-Salem, North Carolina.

The citation for the study by Weinstock-Guttman is Weinstock-Guttman B, Ramanathan M, Lincoff N, et al. Study of mitoxantrone for the treatment of recurrent neuromyelitis optica (Devic disease). Arch Neurol. 2006;63:957-963.