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Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study

Department of Cardiovascular and Neurological Science, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy

C Sardu

Department of Public Health, University of Cagliari, Cagliari, Italy

P Gallo

Multiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, University Hospital of Padova, Padova, Italy

R Capra

Department of Neurology, Multiple Sclerosis Centre, Ospedali Civili di Brescia, Brescia, Italy

MP Amato

Department of Neurology, University of Florence, Florence, Italy

M Trojano

Department of Neurological Sciences, University of Bari, Bari, Italy

A Uccelli

Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy

MG Marrosu

Department of Cardiovascular and Neurological Science, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy gmarrosu{at}unica.it

the FEMIMS group*

Background

Improved prognosis in women with multiple sclerosis (MS) undergoing immunosuppressive treatment with mitoxantrone (MITO) has led to an increased interest in the effect of such treatments on fertility. FErtility and Mitoxantrone In MS (FEMIMS) is a collaborative retrospective study aimed at evaluating the impact of MITO treatment on fertility in women with MS.

Methods

Occurrence of chemotherapy-induced amenorrhea (CIA) was evaluated in 189 women with MS treated with MITO before the age of 45. An "ad hoc" questionnaire, paying particular attention to onset of CIA either during or post-MITO treatment, was administered to each patient. The probability of CIA was calculated using a multivariate logistic regression analysis taking into account age at exposure, cumulative dose, and use of estroprogestinic (EP) drugs during treatment.

Results

Forty-eight (26%) patients presented CIA following MITO. The probability of CIA was increased by 2%/mg/m² of cumulative dose and by 18% for each year of age, whereas it was reduced by administration of EP during treatment.

Conclusions

MITO treatment may affect reproductive capacity in women with MS. Patients of childbearing age should be properly counseled before MITO treatment and EP therapy should be administered to reduce the risk of CIA.

Key Words: amenorrhea • estroprogestinic drug • fertility • immunosuppressive drugs • mitoxantrone • multiple sclerosis

This version was published on November 1, 2008

Multiple Sclerosis, Vol. 14, No. 9, 1225-1233 (2008)
DOI: 10.1177/1352458508094882


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