Chemotherapy for Multiple Sclerosis
For those who suffer from multiple sclerosis, there are a lot of treatments available in managing the symptoms. However, there is no complete cure for this disease. The choice of multiple medications depends on person-to-person since every person’s body responds differently to each treatment. Doctors are now going for chemotherapy for individuals who do not respond to the conventional method of MS treatment.
Chemotherapy is a type of treatment, which was earlier extensively used only for the treatment of cancer. Now, such therapy is being used for managing the symptoms of other types of diseases since there have been research findings that have shown the effectiveness of the treatment.
Conventional Method of Treatment
The conventional method of treating MS depends on the type of multiple sclerosis. The main aim of conventional remedies is to reduce the effect of the symptoms and also reduce or delay the progression and disability caused by the disease. Multiple medications are available both over-the-counter and prescription. If the symptoms are mild and do not frequently show up, then there is no need for medications. However, if the disease is severe leading to frequent flare-ups, then you would need certain treatment to decrease the frequency of flare-ups and also delay the progression of the disease. It would also help you lead a normal life.
The most common medications for multiple sclerosis are methylprednisolone and prednisone, which are given intravenously to the patient. This medicine has to be given once a day for a period of three to five days. These medications are nothing but steroids that help reduce the inflammation to lessen the MS symptoms.
Another conventional method of MS medication is plasmapheresis, which is given only in cases of severe and rapidly progressing MS. It can also be given in cases when the person is not able to respond to the medications given via IV method. In the plasmapheresis treatment, the plasma is separated from the blood. Then the plasma, which is received from the donor, is infused back into the body of the patient. This new plasma will not have the antibodies that the patient with multiple sclerosis had.
Chemotherapy
Chemotherapy is a treatment process that involves the use of drugs that can kill cancer cells. This type of therapy is usually given to patients with cancer. There have been several drugs, which have been used in chemotherapy for the treatment of multiple sclerosis.
In multiple sclerosis, the immune system attacks the myelin sheath, which is based around the nerves of the central nervous system. Chemotherapy drugs are used in killing white blood cells (WBCs) that have become part of the attack. Thus, chemotherapy can help stop or slow down the progression of MS by suppressing the activity of the immune system. This process is also a part of the stem cell therapy.
During chemotherapy treatment, the function of the immune system gets partially or completely impaired. Hence, the stem cells, which were initially collected prior to the treatment, are then returned back to start the production of new immune cells. Chemotherapy is not a process to cure multiple sclerosis, but rather dramatically slow down the progression of the disease.
Why is chemotherapy used for multiple sclerosis?
Chemotherapy is not the preferred first line of medication for the treatment of multiple sclerosis. It is only helpful for individuals who do not respond well to the conventional method of MS treatment. Chemotherapy is known to be an immunosuppressive agent and suppresses the progression of multiple sclerosis. Hence, it is seen to be an option when other medications cannot help. Before starting with the process of chemotherapy, the doctor should first weigh down the pros and cons of the therapy. Chemotherapy should only be started when its benefits outweigh the risks.
Prior to starting the treatment, one has to go in for a blood test to ensure that there will be nothing that would hold up the treatment. Once therapy is done for the day, the nurse would keep a tab on any vital signs prior to and after the treatment. There would be a mix of medications used for the treatment. Chemo is often accompanied by steroid IV such as Solu-Medrol or an anti-nausea medicine. One may also be given IV fluids for the purpose of gaining the energy back.
Since chemo treatment suppresses the immune system, one would be very vulnerable to any kind of infection. Hence, it is advisable for the patient to avoid any kind of crowded places or sick people for the first two weeks of starting the treatment.
Commonly Used Drugs in Chemotherapy
The only drug that has been approved by the Food and Drug Administration for the treatment of multiple sclerosis is Novantrone (mitoxantrone). However, there are other chemotherapy agents, which can be used in this process. Some of those agents include Imuran (azathioprine), Cytoxan (cyclophosphamide) and lastly Leustatin (cladribine).
Novantrone (mitoxantrone)
Mitoxantrone is an anti-cancer medication and is used as a chemotherapy drug. This medicine is classified as an antitumor antibiotic. Mitoxantrone is used for various purposes such as breast cancer, advanced cases of prostate cancer, leukemia, and now, in the treatment of multiple sclerosis.
Mitoxantrone is given in the form of injection, which is infused into the vein or intravenous IV. This medicine can act as an irritant, which could cause inflammation of the vein, through which it was given. Mitoxantrone can also lead to damage to the tissues if it escapes from the veins. Hence, the doctor or nurse who would be injecting this medicine in the veins should be doing it with a lot of care. If there is any kind of pain, swelling, or redness at the site of the injection or while receiving it, then one must not delay informing the doctor.
There are many factors that would decide the dosage of mitoxantrone to be used for the treatment. The doctor would consider the height and weight of the individual, the overall health of the person, and the type of condition being treated. The doctor would also decide the dose and the schedule of the treatment.
Mitoxantrone also has certain side effects, which one may or may not experience. There are certain side effects that are reversible, but some cannot be reversed. Thus, the main aim should be to minimize the side effects as much as possible to avoid too much of a discomfort to the individual.
Some of the commonly known side effects of mitoxantrone are fever, chills, nausea, vomiting, and a low count of blood. The lesser known side effects are:
- Thinning or loss of hair
- Sores or ulcers in the mouth
- Overall weakness
- Low blood pressure
- Abnormalities in the heart rhythm
- Diarrhea
- Discoloration of the sclera (white part of the eye)
- Changes in the color of the urine, which happens one or two days after the treatment
- Abnormal ECG
One of the severe and less common side effects of mitoxantrone is medicine interference with pumping action of the heart. In a lifetime, one can only receive a certain amount of mitoxantrone dosage. The dosage can be lowered by the doctor if:
- The patient already had radiation to the chest
- An elderly person
- Uses drugs that are toxic to the heart
Before prescribing mitoxantrone, the doctor would first conduct a check-up of the heart function. Moreover, during the course of the treatment, the heart would be periodically monitored for any signs of abnormalities. Immediately seek medical attention if you experience any of the following conditions:
- High fever that goes up to more than 100 degrees Fahrenheit
- Persistent vomiting
- Bloody or tarry stools
- Severe nausea
- Easy bruising
- Unusual bleeding
- Skin turning pale or yellow
- Irregular breathing
- Signs of infections such as cough, fever, and sore throat
- Red and painful mouth sores
Before starting the treatment of mitoxantrone, ensure to inform the doctor if you are already on any kind of medication to make sure that there will be no drug interactions. Do not consume aspirin or any other products containing the contents similar to aspirin unless approved by the doctor. Do not take any kind of vaccination or immunization during the course of treatment. Inform the doctor if one is pregnant or planning to get pregnant since mitoxantrone can cause damage to the fetus. One should not nurse a baby during the course of treatment as the drug can pass through the breast milk and cause harm. The following are certain tips one should keep in mind to ensure that the treatment goes on smoothly:
- Drink enough of water at least eight to ten glasses a day.
- Bring about some dietary changes to your daily eating habits by including more nutritious foods.
- Wash your hands as often as possible to avoid contracting any type of infection.
- Take plenty of rest.
- Keep all kinds of stress at bay since any kind of stress can interfere with the treatment.
- To avoid nausea, take anti-nausea drugs as prescribed by the doctor.
- Avoid sun exposure or make sure that you wear protective clothing while under the sun.
- To reduce the risk of developing infections, avoid crowded places or visiting other people who are sick.
The doctor would conduct a baseline evaluation of the heart prior to starting the treatment. Apart from this, a heart function test would also be requested by the doctor. The doctor would regularly check for any side effects while you are under mitoxantrone treatment. The response to the therapy would also be checked by the doctor. A periodic blood test would also be carried out to check your blood count and to see if your organs are functioning well.
The strength of chemotherapy agents to kill cancer-causing cells would depend on their ability to inhibit the division of the cells. Usually, these drugs work by damaging the DNA and RNA, and tell other cells how to copy itself in division. If the cells are unable to copy, they die. The faster the division of cells happen, the more likely it is for the chemotherapy drug to kill the cells, leading to the shrinkage of the tumor. Such therapy also induces self-death of the cells.
Chemotherapy is known to be the most effective treatment method in killing rapidly dividing cells. However, the only disadvantage here is that it does not know the difference between normal and cancer-causing cells. The normal cells do grow back again, and also become healthy, but side effects are still experienced while on chemotherapy. Different types of drugs react differently to various parts of the body.
Side Effects
One of the scariest part of chemotherapy treatment is its side effects. Aside from the symptoms of MS, one would also go through the side effects of chemotherapy. Below are the side effects of chemotherapy that cannot be ignored:
- Loss or thinning of hair
- Any type of infection
- Nausea
- Lack of coordination
- Cardiomyopathy (heart muscle disease)
- Leukemia
- Vomiting
- Inflammation of the liver
