Late Cardiotoxicity in MS Patients Treated with Mitoxantrone

Abstract

Context: Mitoxantrone (MTX) is an antracyclin drug that is used for treatment of patients with
chronic refractory multiple sclerosis (MS). Congestive heart failure (CHF) is a rare complication of
this drug that may occur early, during therapy, or late, months or years after termination of therapy.

Aims: The aim of this study is to evaluate the long‑term adverse effect of MTX on cardiac function.

Methods: The study involved 49 MS patients on MTX therapy because of their disease was refractory
to other treatments (18 men and 31 women). They were treated in two canters related to Esfahan
University of Medical Sciences. The mean age was 34.65 ± 9.56 years. Systolic and diastolic left
ventricular (LV) functions were measured by echocardiography. The baseline echocardiographic data
were collected from patients’ file. Echocardiography was repeated by a single cardiologist in 2016.

Results: After MTX therapy, one patient’s ejection fraction (EF) reduced below 50% (2%). In spite
of their normal diastolic function before therapy, two patients developed diastolic dysfunction (4%).
Nonparametric binominal analysis reveals that MTX therapy increased the probability of developing
systolic dysfunction, early or late P < 001.

Conclusions: MS patients treated with MTX are at
increased risk of developing early and late‑LV dysfunction, so all patients on MTX therapy must be
periodically evaluated for these late complications.

Keywords: Heart failure, mitoxantrone, multiple sclerosis