Home Toxic Effects

In a recently published the results of a multicenter European Phase II trial, which placebo-controlled, randomized, blind protocol.Found a significant positive impact on the frequency of relapses and the evolution of the deficit, and not accompanied by acute toxic effects. The information MRI beneficial effect on disease activity. Treatment was well tolerated. Although the results of this study led to the approval of mitoxantrone for the treatment of MS by the FDA in 2002, was not published the results in a scientific journal with peer review.

Home toxic effects of mitoxantrone is myelosuppression and cardiotoxicity dose.

Therefore, if the treatment with mitoxantrone, it is extremely important that patients who suffer from heart disease and an observer (depending on the treatment regimen used) ECG, blood and urine analysis to exclude the results on a monthly basis and an echocardiogram every six months.

Mitoxantrone

 Mitoxantrone is mediated antineoplastic agent with a strong immunological effects, including by inhibiting immune B cells and lymphocytes-T, is much less toxic anti-cancer drugs other, is the most common serious side effects cardiotoxicity. This compound is the subject of three trials for the treatment of MS in recent years.

Last placebo-controlled, randomized, conducted in Italy of 51 patients with RRMS. The treatment was to be in the 8 mg/m2 administered intravenously once a month for a year. A were measured downward trend in disease activity by evaluating clinical outcomes and magnetic resonance imaging (MRI) and shown in this study.

Conducted last placebo-controlled, randomized, with the expected duration of two years in Italy, from 51 patients with RRMS. The treatment was to be in the 8 mg/m2 administered intravenously once a month for a year. A were measured downward trend in disease activity by evaluating clinical outcomes and magnetic resonance imaging (MRI) and shown in this study.

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Cladribine (2-chlorodeoxyadenosine)

 
 Cladribine is an immunosuppressive agent that leads to the destruction of relatively selective cells (apoptosis) and because of its toxicity and cellular resistance to adenosine deaminase. Has been studied in patients who suffer from MS, and is used in the treatment of lymphoid malignancies and other autoimmune diseases.

Results after the first year of a double-blind crossover study, and placebo in 50 patients with MS-out, which was scheduled to last two years are favorable. Patients remained (measured in degrees and the total volume of neural lesion on MRI) stable or improved in patients treated with cladribine, but it became worse in patients who received placebo. These positive results have not, however, in recent randomized Phase III study in 159 patients out with MS receiving cladribine administered two different doses (and reiterates 0.7 or 2.1 mg / kg) or placebo. Topics that were monthly assessments for 12 months, and the serial number undergo evaluation of disability scores and classroom MRI. Although treatment with cladribine have a major impact in reducing lesions on MRI, there was no significant impact on the deficit. Side effects of this drug are myelosuppression and susceptibility to viral infection (including herpes zoster).

Methotrexate

Methotrexate is immune. The oral administration of a relatively low dose, effective and non-toxic in other autoimmune diseases such as rheumatoid arthritis and psoriasis. The first test showed in the treatment of MS some decline in the frequency of relapses, but no benefit in patients suffering from Multiple Sclerosis gradual.

In a recent study, 60 ambulatory patients with progressive MS, and moderate or severe disability in the methotrexate 7.5 mg per week or placebo for two years. In the group that received treatment, significantly reduced the damage in the composite endpoint (EDSS arm evaluation function), it was noted the maximum benefit of the study early.

However, this is not important treatment effect when analyzed according to the traditional endpoint and EDSS. The impact of the disease on MRI activity also marginal. This was well tolerated low-dose methotrexate and no patient treatment stalled because of adverse events. Can it be treated for long periods with methotrexate cause irritation of the mucous membranes, and gastrointestinal symptoms, liver, and pulmonary fibrosis, and myelosuppression.

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Cyclosporine A

 
Cyclosporine A is an immunosuppressive agent used to improve the effectiveness of the success rate of the heart, kidneys and liver. It has also proven to be helpful in the treatment of certain autoimmune diseases. It in a series of studies on MS, the largest of which were analyzed workforce of 547 patients suffering from Multiple Sclerosis chronic progressive, it was found that a slight decrease in the rate of disease progression and a slight increase in the time before using the wheelchair. This modest or marginal benefits, and comes at the expense of long-term toxicity (kidney weakness and high blood pressure).

Cyclophosphamide

 
Cyclophosphamide is another immunosuppressive agent used for many years in the treatment of MS. It was originally uncontrolled studies that evaluated often, but not always, and show that improvement. Product in chronic progressive MS, particularly in patients who suffer from a disability is very light at the beginning of treatment the largest study so far, multicenter showed any positive effect. Cyclophosphamide has many side effects such as hair loss, nausea, vomiting, hemorrhagic cystitis, infertility, infections and cancer. Some doctors. Cyclophosphamide also still with shock therapy in the case of patients who deteriorate quickly, citing allegations that the stability of the disease treatment requires close monitoring and ongoing patient, including blood count, liver function tests and urinalysis.

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Azathioprine

Azathioprine is an immunosuppressant used widely in the treatment of various autoimmune diseases. He was extracted from the analysis of the results of randomized trials 7 (five and two double-blind, single blind) with patients who suffer from MS 793 by oral azathioprine (1-3 mg/kg/m2) reduces the frequency of relapses and little impact very EDSS. These results have been criticized on the grounds that used a sufficient dose of azathioprine in some studies. Side effects of azathioprine toxicity, gastrointestinal tract, and blood and liver. Another risk potential long-term cancer, but in the controlled trial, case-control, short-term (less than 5 years) are not associated with significantly increased risk. Treatment requires close monitoring and ongoing patient, including blood counts and liver function tests.