Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Mitoxantrone (Novantrone) is a Food and Drug Administration (FDA) approved immunosuppressant used in
multiple sclerosis. Other immunosuppressants, such as cyclophosphamide (Cytoxan), azathioprine (Imuran), or methotrexate
(Rheumatrex, Trexall), are prescribed primarily in specialized centers; but their efficacy in
multiple sclerosis remains controversial and they are not FDA approved for this use. These drugs should not substitute for the immune-modulating drugs as first-line agents in newly diagnosed relapsing remitting multiple sclerosis (RRMS). Some physicians find a role for Cytoxan, Imuran, and methotrexate as last-resort measures for patients who have not responded to the FDA approved drugs or that have a fulminant (malignant) course of
multiple sclerosis that may be life threatening.
How immunosuppressants work: This group includes a wide variety of agents that work in many different ways, but they all interfere in the immune-system processes that cause inflammation.
Who should not use these medications:
Individuals allergic to any of these drugs
Women who are pregnant or breastfeeding
Individuals with preexisting bone marrow suppression
Use: Depending on the drug prescribed, immunosuppressants may be administered orally or intravenously.
Drug or food interactions: The use of immunosuppressants increases the risk of infection, increases toxicity to bone marrow or blood cells, and may lead to cancer. Many drug interactions are possible. Contact a doctor or pharmacist before beginning a new prescription or over-the-counter medication.
Side effects: Immunosuppressants are not safe during pregnancy, may cause bone marrow or blood cell toxicity, or may lead to cancer. Patients with impaired kidney or liver function may need lower doses and close monitoring. Methotrexate may cause toxicity of the liver or lungs (fibrosis or pneumonitis) and even damage to the nervous system (leukoencephalopathy or myelopathy). Mitoxantrone may cause heart problems and requires monitoring with echocardiograms (ultrasonography of the heart) before and during therapy. Cyclophosphamide may cause bleeding within the bladder and even bladder cancer. Follow the doctor's recommendations on fluid intake while taking these medications.
Indications for Immunosuppressant Drugs in multiple sclerosis
Mitoxantrone (Novantrone): indicated for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (i.e., patients whose neurologic status is significantly abnormal between relapses). Novantrone is not indicated in the treatment of patients with primary progressive multiple sclerosis.