Mitoxantrone (Novantrone®) was the first drug approved in western Europe and
North A merica for treatment of secondary progressive multiple sclerosis (SPMS) and
progressive relapsing MS (PRMS). Pharmacological properties of mitoxantrone, its
role in SPMS, the study rational and design of an ongoing multi-centre, double
blind, randomized, placebo -controlled phase 2 trial will be outlined in this article.
Lublin FD, Reingold SC.Defining the clinical course of multiple sclerosis: results of an
international survey. National Multiple Sclerosis Society (USA) Advisory
Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology1996; 46: 907-911.
2.
Confavreux C, Aimard G, Devic M.Course and prognosis of multiple sclerosis assessed by the computerized
data processing of 349 patients. Brain1980; 103: 281-300.
3.
Verjans E, Theys P, Delmotte P, Carton H.Clinical parameters and intrathecal IgG synthesis as prognostic features in
multiple sclerosis. Part I. J Neurol1983; 229: 155-165.
4.
Minderhoud JM, van der Hoeven JH, Prange AJ.Course and prognosis of chronic progressive multiple sclerosis. Results of
an epidemiological study. Acta Neurol Scand1988; 78: 10-15.
5.
Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, et al.The natural history of multiple sclerosis: a geographically based study. I.
Clinical course and disability. Brain1989; 112: 133-146.
6.
McDonnell GV, Hawkins SA.An epidemiologic study of multiple sclerosis in Northern Ireland. Neurology1998; 50: 423-428.
7.
Andersson PB, Waubant E, Gee L, Goodkin DE.Multiple sclerosis that is progressive from the time of onset: clinical
characteristics and progression of disability. Arch Neurol1999; 56: 1138-1142.
8.
Cottrell DA, Kremenchutzky M, Rice GP, Koopman WJ, Hader W, Baskerville J, et al.The natural history of multiple sclerosis: a geographically based study. 5.
The clinical features and natural history of primary progressive multiple sclerosis. Brain1999; 122: 625-639.
9.
Durr FE, Wallace RE, Citarella RV.Molecular and biochemical pharmacology of mitoxantrone. Cancer Treat Rev1983; 10: 3-11.
10.
Alberts DS, Peng YM, Bowden GT, Dalton WS, Mackel C.Pharmacology of mitoxantrone: mode of action and pharmacokinetics. Invest New Drugs1985; 3: 101-107.
11.
Ehninger G, Proksch B, Heinzel G, Woodward DL.Clinical pharmacology of mitoxantrone. Cancer Treat Rep1986; 70: 1373-1378.
12.
Harker WG, Slade DL, Parr RL, Feldhoff PW, Sullivan DM, Holguin MH.Alterations in the topoisomerase II alpha gene, messenger RNA, and
subcellular protein distribution as well as reduced expression of the DNA
topoisomerase II beta enzyme in a mitoxantrone-resistant HL-60 human
leukemia cell line. Cancer Res1995; 55: 1707-1716.
13.
Chiang SY, Azizkhan JC, Beerman TA.A comparison of DNA- binding drugs as inhibitors of E2F1- and Sp1-DNA
complexes and associated gene expression. Biochemistry1998; 37: 3109-3115.
14.
Gaidarova S, Jimenez SA.Inhibition of basal and transforming growth factor-beta-induced stimulation
of COL1A1 transcription by the DNA intercalators, mitoxantrone and WP631, in
cultured human dermal fibroblasts. J Biol Chem2002; 277: 38737-38745.
15.
Fidler JM, DeJoy SQ, Gibbons JJ, Jr.Selective immunomodulation by the antineoplastic agent mitoxantrone. I.
Suppression of B lymphocyte function. J Immunol1986; 137: 727-732.
16.
Fidler JM, DeJoy SQ, Smith FR, III, Gibbons JJ, Jr.Selective immunomodulation by the antineoplastic agent mitoxantrone. II.
Nonspecific adherent suppressor cells derived from mitoxantrone-treated mice. J Immunol1986; 136: 2747-2754.
17.
Wang BS, Lumanglas AL, Silva J, Ruszala-Mallon VM, Durr FE.Inhibition of the induction of alloreactivity with mitoxantrone. Int J Immunopharmacol1986; 8: 967-973.
18.
Savaraj N, Lu K, Manuel V, Loo TL.Pharmacology of mitoxantrone in cancer patients. Cancer Chemother Pharmacol1982; 8: 113-117.
19.
Wiseman LR, Spencer CM.Mitoxantrone. A review of its pharmacology and clinical efficacy in the
management of hormone-resistant advanced prostate cancer. Drugs Aging1997; 10: 473-485.
20.
Ghalie RG, Edan G, Laurent M, Mauch E, Eisenman S, Hartung HP, et al.Cardiac adverse effects associated with mitoxantrone (Novantrone) therapy
in patients with MS. Neurology2002; 59: 909-913.
21.
Ghalie RG, Mauch E, Edan G, Hartung HP, Gonsette RE, Eisenmann S, et al.A study of therapy-related acute leukaemia after mitoxantrone therapy for
multiple sclerosis. Mult Scler2002; 8: 441-445.
22.
Edan G, Brochet B, Brassat D, Clanet M, Clavelou P, Confavreux C, et al.Safety profile of mitoxantrone in a cohort of 802 multiple sclerosis patients. American Academy of Neurology 54th Annual Meeting Program
A168. 4-16-2002.
23.
Gonsette RE.Mitoxantrone immunotherapy in multiple sclerosis. Mult Scler1996; 1: 329-332.
24.
Hagemeister FB.Are alkylating agents a necessary component in the therapy of
Hodgkin’s disease. Leuk Lymphoma1993; 10: 91-97.
25.
Edan G, Miller D, Clanet M, Confavreux C, Lyon-Caen O, Lubetzki C, et al.Therapeutic effect of mitoxantrone combined with methylprednisolone in
multiple sclerosis: a randomised multicentre study of active disease using
MRI and clinical criteria. J Neurol Neurosurg Psychiatry1997; 62: 112-118.
26.
Hartung HP, Gonsette R, Konig N, Kwiecinski H, Guseo A, Morrissey SP, et al.Mitoxantrone in progressive multiple sclerosis: a placebo-controlled,
double-blind, randomised, multicentre trial. Lancet2002; 360: 2018-2025.
27.
Interferon beta-1b is effective in relapsing-remitting multiple sclerosis.
I. Clinical results of a multicenter, randomized, double-blind,
placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology1993; 43: 655-661.
28.
Paty DW, Li DK.Interferon beta-1b is effective in relapsing-remitting multiple sclerosis.
II. MRI analysis results of a multicenter, randomized, double-blind,
placebo-controlled trial. UBC MS/MRI Study Group and the IFNB Multiple
Sclerosis Study Group. Neurology1993; 43: 662-667.
29.
Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, et al.Intramuscular interferon beta-1a for disease progression in relapsing
multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol1996; 39: 285-294.
30.
PRISMS-4. Long-term efficacy of interferon-beta-1a in relapsing MS. Neurology2001; 56: 1628-1636.
31.
Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, et al.Copolymer 1 reduces relapse rate and improves disability in relapsing
-remitting multiple sclerosis: results of a phase III multicenter,
double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis
Study Group. Neurology1995; 45: 1268-1276.
32.
Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, et al.Extended use of glatiramer acetate (Copaxone) is well tolerated and
maintains its clinical effect on multiple sclerosis relapse rate and degree
of disability. Copolymer 1 Multiple Sclerosis Study Group. Neurology1998; 50: 701-708.
33.
Johnson KP, Brooks BR, Ford CC, Goodman A, Guarnaccia J, Lisak RP, et al.Sustained clinical benefits of glatiramer acetate in relapsing multiple
sclerosis patients observed for 6 years. Copolymer 1 Multiple Sclerosis
Study Group. Mult Scler2000; 6: 255-266.
34.
Ge Y, Grossman RI, Udupa JK, Fulton J, Constantinescu CS, Gonzales-Scarano F, et al.Glatiramer acetate (Copaxone) treatment in relapsing -remitting MS:
quantitative MR assessment. Neurology2000; 54: 813-817.
35.
Comi G, Filippi M, Wolinsky JS.European/Canadian multi-center, double-blind, randomized,
placebo-controlled study of the effects of glatiramer acetate on magnetic
resonance imaging - measured disease activity and burden in patients with
relapsing multiple sclerosis. European/Canadian Glatiramer Acetate Study Group. Ann Neurol2001; 49: 290-297.