"Just as 'video killed the radio star' new DMTs kill older therapies. We mustn't forget that the relentless drive of innovation is changing the face of MS management. Don't expect innovation to stop the MS development pipeline is deep and rich, which is why I am such an optimist."
Epub: Ellis et al. Therapy-related acute leukaemia with mitoxantrone: Four years on, what is the risk and can it be limited? Mult Scler. 2014 Jul .
Background: Therapy-related acute leukaemia (TRAL) is a significant concern, when considering treatment with mitoxantrone for MS.
Methods: We re-evaluated the literature, identifying all case reports and series of > 50 patients reporting TRAL cases in MS.
Results: TRAL was diagnosed in 0.73% of the 12,896 MSers identified. Median onset was 22 months following treatment. We calculated a number needed to harm of 137.5 exposed MSers, significantly higher than our 2008 analysis. We found that 82.8% of MSers were exposed to > 60 mg/m2 with a relative risk of 1.85 (p = 0.018) compared to < 60mg/m2, strongly suggesting a relationship to dose.
Conclusion: MS treatment regimens which limit the mitoxantrone dose to < 60mg/m2 reduce the risk of TRAL.