Cardiotoxicity of Mitoxantrone Treatment in a German Cohort of 639 Multiple Sclerosis Patients
Journal of Clinical Neurology 2014³â 10±Ç 4È£ p.289 ~ p.295
(Fleischer Vinzenz) - Johannes Gutenberg University of Mainz University Medical Center Department of Neurology
(Salmen Anke) - Ruhr University of Bochum St. Josef-Hospital Department of Neurology
(Kollar Susanne) - Ruhr University of Bochum St. Josef-Hospital Department of Neurology
(Weyer Veronika) - Johannes Gutenberg University of Mainz University Medical Center Institute of Medical Biostatistics
(Siffrin Volker) - Johannes Gutenberg University of Mainz University Medical Center Department of Neurology
(Chan Andrew) - Ruhr University of Bochum St. Josef-Hospital Department of Neurology
(Zipp Frauke) - Johannes Gutenberg University of Mainz University Medical Center Department of Neurology
(Luessi Felix) - Johannes Gutenberg University of Mainz University Medical Center Department of Neurology
Abstract
Background and Purpose: The aim of this study was to elucidate the role of therapy-related cardiotoxicity in multiple sclerosis (MS) patients treated with mitoxantrone and to identify potential predictors for individual risk assessment.
Methods: Within a multicenter retrospective cohort design, cardiac side effects attributed to mitoxantrone were analyzed in 639 MS patients at 2 MS centers in Germany. Demographic, disease, treatment, and follow-up data were collected from hospital records. Patients regularly received cardiac monitoring during the treatment phase.
Results: None of the patients developed symptomatic congestive heart failure. However, the frequency of patients experiencing cardiac dysfunction of milder forms after mitoxantrone therapy was 4.1% (26 patients) among all patients. Analyses of the risk for cardiotoxicity revealed that cumulative dose exposure was the only statistically relevant risk factor associated with cardiac dysfunction.
Conclusions: The number of patients developing subclinical cardiac dysfunction below the maximum recommended cumulative dose is higher than was initially assumed. Interestingly, a subgroup of patients was identified who experienced cardiac dysfunction shortly after initiation of mitoxantrone and who received a low cumulative dose. Therefore, each administration of mitoxantrone should include monitoring of cardiac function to enhance the treatment safety for patients and to allow for early detection of any side effects, especially in potential high-risk subgroups (as determined genetically).
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multiple sclerosis, mitoxantrone, cardiotoxicity, dose dependency
KMID :
1130620140100040289
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