Cardiovascular comorbidity in multiple sclerosis patients treated with mitoxantrone therapy: a cohort study

Giovanni Savettieri, Paolo Aridon, Marco D'Amelio, Alessia Bianchi, Giuseppe Salemi, Sabrina Realmuto, Paolo Ragonese, Erika Portera, Fabio Triolo, Giulia Vazzoler, Maria Antonietta Mazzola, Simona Alessi

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Abstract

Background Mitoxantrone (MX) has been used as second line therapy for aggressive multiple sclerosis (MS). Potential cardiotoxic effects of MX limit its use; a cumulative dose of up to 100 mg/m2, has been long considered relatively safe. We calculated the frequency of cardiac side effects in MS patients treated with MX. Methods We performed a cohort study including all MS patients treated with MX at the Neurological Department of the University Hospital of Palermo, Italy. Two hundred-sixty-four MS patients diagnosed according to validated criteria were included and followed-up until the end of September 2010. Patients were treated with MX as a second line therapy if they had no previous heart diseases determined by clinical evaluation, electrocardiography, and echocardiography. Treatment administration was made at a monthly dose of 8 mg/m2 for the first three months and at a dose of 12 mg/m2 every three months. Echocardiography was routinely performed every six months. Treatment was stopped before reaching the final dose if signs had appeared of impaired heart function, confirmed left ventricular ejection fraction reduction lower to 50%, or a confirmed reduction of more than 10% with respect to the first examination. Results Heart involvement was observed in 12.4% of treated individuals, and symptomatic congestive heart failure occurred in 2.7% of the cohort. A patient had a myocardial infarction, and 3.1% showed electrocardiographic anomalies not present at baseline. Conclusion Our study confirms that cardiac adverse events associated with MX are more common than previously reported.
Lingua originaleEnglish
pagine (da-a)1-5
Numero di pagine5
RivistaMultiple Sclerosis and Demyelinating Disorders
Volume2
Stato di pubblicazionePublished - 2017

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Mitoxantrone
Multiple Sclerosis
Comorbidity
Cohort Studies
Echocardiography
Therapeutics
Stroke Volume
Italy
Heart Diseases
Electrocardiography
Heart Failure
Myocardial Infarction

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title = "Cardiovascular comorbidity in multiple sclerosis patients treated with mitoxantrone therapy: a cohort study",
abstract = "Background Mitoxantrone (MX) has been used as second line therapy for aggressive multiple sclerosis (MS). Potential cardiotoxic effects of MX limit its use; a cumulative dose of up to 100 mg/m2, has been long considered relatively safe. We calculated the frequency of cardiac side effects in MS patients treated with MX. Methods We performed a cohort study including all MS patients treated with MX at the Neurological Department of the University Hospital of Palermo, Italy. Two hundred-sixty-four MS patients diagnosed according to validated criteria were included and followed-up until the end of September 2010. Patients were treated with MX as a second line therapy if they had no previous heart diseases determined by clinical evaluation, electrocardiography, and echocardiography. Treatment administration was made at a monthly dose of 8 mg/m2 for the first three months and at a dose of 12 mg/m2 every three months. Echocardiography was routinely performed every six months. Treatment was stopped before reaching the final dose if signs had appeared of impaired heart function, confirmed left ventricular ejection fraction reduction lower to 50{\%}, or a confirmed reduction of more than 10{\%} with respect to the first examination. Results Heart involvement was observed in 12.4{\%} of treated individuals, and symptomatic congestive heart failure occurred in 2.7{\%} of the cohort. A patient had a myocardial infarction, and 3.1{\%} showed electrocardiographic anomalies not present at baseline. Conclusion Our study confirms that cardiac adverse events associated with MX are more common than previously reported.",
author = "Giovanni Savettieri and Paolo Aridon and Marco D'Amelio and Alessia Bianchi and Giuseppe Salemi and Sabrina Realmuto and Paolo Ragonese and Erika Portera and Fabio Triolo and Giulia Vazzoler and Mazzola, {Maria Antonietta} and Simona Alessi",
year = "2017",
language = "English",
volume = "2",
pages = "1--5",
journal = "Multiple Sclerosis and Demyelinating Disorders",
issn = "2056-6115",
publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - Cardiovascular comorbidity in multiple sclerosis patients treated with mitoxantrone therapy: a cohort study

AU - Savettieri, Giovanni

AU - Aridon, Paolo

AU - D'Amelio, Marco

AU - Bianchi, Alessia

AU - Salemi, Giuseppe

AU - Realmuto, Sabrina

AU - Ragonese, Paolo

AU - Portera, Erika

AU - Triolo, Fabio

AU - Vazzoler, Giulia

AU - Mazzola, Maria Antonietta

AU - Alessi, Simona

PY - 2017

Y1 - 2017

N2 - Background Mitoxantrone (MX) has been used as second line therapy for aggressive multiple sclerosis (MS). Potential cardiotoxic effects of MX limit its use; a cumulative dose of up to 100 mg/m2, has been long considered relatively safe. We calculated the frequency of cardiac side effects in MS patients treated with MX. Methods We performed a cohort study including all MS patients treated with MX at the Neurological Department of the University Hospital of Palermo, Italy. Two hundred-sixty-four MS patients diagnosed according to validated criteria were included and followed-up until the end of September 2010. Patients were treated with MX as a second line therapy if they had no previous heart diseases determined by clinical evaluation, electrocardiography, and echocardiography. Treatment administration was made at a monthly dose of 8 mg/m2 for the first three months and at a dose of 12 mg/m2 every three months. Echocardiography was routinely performed every six months. Treatment was stopped before reaching the final dose if signs had appeared of impaired heart function, confirmed left ventricular ejection fraction reduction lower to 50%, or a confirmed reduction of more than 10% with respect to the first examination. Results Heart involvement was observed in 12.4% of treated individuals, and symptomatic congestive heart failure occurred in 2.7% of the cohort. A patient had a myocardial infarction, and 3.1% showed electrocardiographic anomalies not present at baseline. Conclusion Our study confirms that cardiac adverse events associated with MX are more common than previously reported.

AB - Background Mitoxantrone (MX) has been used as second line therapy for aggressive multiple sclerosis (MS). Potential cardiotoxic effects of MX limit its use; a cumulative dose of up to 100 mg/m2, has been long considered relatively safe. We calculated the frequency of cardiac side effects in MS patients treated with MX. Methods We performed a cohort study including all MS patients treated with MX at the Neurological Department of the University Hospital of Palermo, Italy. Two hundred-sixty-four MS patients diagnosed according to validated criteria were included and followed-up until the end of September 2010. Patients were treated with MX as a second line therapy if they had no previous heart diseases determined by clinical evaluation, electrocardiography, and echocardiography. Treatment administration was made at a monthly dose of 8 mg/m2 for the first three months and at a dose of 12 mg/m2 every three months. Echocardiography was routinely performed every six months. Treatment was stopped before reaching the final dose if signs had appeared of impaired heart function, confirmed left ventricular ejection fraction reduction lower to 50%, or a confirmed reduction of more than 10% with respect to the first examination. Results Heart involvement was observed in 12.4% of treated individuals, and symptomatic congestive heart failure occurred in 2.7% of the cohort. A patient had a myocardial infarction, and 3.1% showed electrocardiographic anomalies not present at baseline. Conclusion Our study confirms that cardiac adverse events associated with MX are more common than previously reported.

UR - http://hdl.handle.net/10447/358016

M3 - Article

VL - 2

SP - 1

EP - 5

JO - Multiple Sclerosis and Demyelinating Disorders

JF - Multiple Sclerosis and Demyelinating Disorders

SN - 2056-6115

ER -