Mitoxantrone: Mechanism of action and Side effects

What is Mitoxantrone?

Mitoxantrone is a synthetic anthraquinone-based chemotherapy drug approved by the FDA for the treatment of worsening relapsing-remitting multiple sclerosis (MS), secondary progressive MS, and progressive relapsing MS. It is also approved for the treatment of adult acute myeloid leukaemia and symptomatic hormone-refractory prostate cancer. It is mostly given as an injection and can be taken alone or in combination with other medications.

Mechanism of action

Mitoxantrone works through multiple mechanisms to slow disease progression. It inhibits the proliferation of immune cells (including T-cells, B-cells, and macrophages), impairs antigen presentation, and reduces the secretion of pro-inflammatory cytokines.Mitoxantrone enhances T-cell suppression and inhibits B-cell function and antibody production. Finally, it inhibits macrophage-mediated degradation of myelin. In contrast to interferon beta, Mitoxantrone has a broad spectrum of effects on many different types of immune cells.

Side effects

Common side effects of Mitoxantrone include: headache, diarrhoea, nausea, vomiting, hair loss, pain (mouth and throat), menstrual abnormalities (fewer or no periods), infections (upper respiratory and urinary tract infections), tiredness, fever, hives, rash. Rare but some of the more serious side effects include: constipation, loss of appetite, redness and swelling at the injection site, weight changes, increased sweating, loss of fingernails, darkening of the skin and nails; bluish/greenish changes in the urine, skin, eyes, and saliva; damage to the heart or heart failure, which may result in shortness of breath, tiredness, and puffiness; bruising, bleeding, anaemia, liver damage, abnormalities in sexual functioning, apprehension, depression.

References:

[1] FOX E J. Mechanism of action of mitoxantrone.[J]. Neurology, 2004, 63 12 Suppl 6: S15-8. DOI:10.1212/wnl.63.12\_suppl\_6.s15.

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