Long-term experience with induction treatment regimens in multiple sclerosis

The concept of induction treatment followed by a long-term maintenance treatment has attracted much attention for the treatment of multiple sclerosis. In particular, the combination of induction therapy with mitoxantrone followed by maintenance therapy with an immunomodulatory treatment such as an interferon-β or glatiramer acetate is of particular interest. This approach is suitable for patients with particularly aggressive disease, characterised by frequent early relapses with incomplete recovery and multiple gadolinium-enhancing T1 lesions on magnetic resonance imaging. Long-term studies show that a short (six-month) course of mitoxantrone provides a rapid reduction in disease activity and sustained disease control up to at least five years of maintenance therapy with an immunomodulatory treatment. Clinical benefit seems to be greatest when patients with aggressive disease are treated early. Randomised studies have demonstrated that induction with mitoxantrone followed by maintenance treatment provides superior disease control to monotherapy with an interferon-β. With the treatment protocol recommended for use in France (six monthly administrations of mitoxantrone iv at a cumulative dose of 72 mg/m2), mitoxantrone is generally well-tolerated. These findings encourage the use of such induction regimens in patients who present early signs of aggressive disease.