Mitoxantrone and immunoglobulins - indications, effectiveness, side effects

Mitoxantrone is nowadays the most important drug within escalation therapy of relapsing-remitting (RR-MS) and secondary progressive (SP-MS) multiple sclerosis. It may reduce the frequency of relapses and decelerate progression of clinical symptoms as well as of radiologic findings, e.g. whole lesion load and number of Gadolinium-enhancing lesions. Mitoxantrone is usually well tolerated. Nevertheless due to the risk of cardiomyopothy not more than 140 mg/m(2) should be administered during life. Moreover, there is a very small risk that leukaemia may develop as a sequel of mitoxontrone treatment. Intravenous immunoglobulins (IVIg) have been investigated especially in RR-MS and in pregnant women with MS. The results demonstrate a reduction of the frequency of relapses and therefore IVIg may be used in RR-MS in cases when beta-interferon or glatirameracetate are not tolerated well. According to published data, IVIg do not play a role in the treatment of secondary progressive MS or to enhance remyelination. They are usually well tolerated, too. Because of their off label status IVIg are reimbursed by health insurances in only rare cases.