Novantrone or Tysabri for Multiple Sclerosis

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MS Medications. sturti / Getty Images

Novantrone (mitoxantrone) and Tysabri (natalizumab) are both used in similar circumstances to treat multiple sclerosis – for people with worsening relapsing-remitting multiple sclerosis (RRMS) or progressive-relapsing multiple sclerosis (PRMS). Novantrone is indicated for secondary-progressive multiple sclerosis (SPMS), and Tysabri may help out in cases of SPMS where active lesions still show up on MRIs, as well. Neither one is for primary-progressive MS.

This means that many people who have one of these types of MS have a choice to make: Tysabri or Novantrone. While it would be great if one had a huge margin of advantages over the other in all aspects, this is not the case. Like everything else with MS seems to be, the Tysabri vs. Novantrone decision is based on a bunch of complicated factors. The choice needs to be based on personal preference and lifestyle, physician recommendation and access, and other factors such as cost, fear of specific side effects and monitoring requirements.

In this article, I have done my best to compare Tysabri to Novantrone side-by-side on many of the aspects of treatment that I know people are most interested in. Let me point out that these drugs each have a completely different mechanism of action, so it is not as if one drug does its job “better” – they do different things, but with the same goal of slowing disability progression and preventing MS relapses. Tysabri is a monoclonal antibody that prevents certain T-cells from crossing the blood-brain barrier, while Novantrone is chemotherapy that suppresses immune activity.

Here are some things to consider when making your choice:

Your Doctor’s Access and Experience

Only doctors registered with the TOUCH monitoring program can prescribe Tysabri. Many people whose doctor does not have access to Tysabri end up switching to a neurologist that does have access. Any doctor can prescribe Novantrone, however, it is recommended that it be administered by a doctor with experience in monitoring and caring for patients receiving chemotherapy of this nature.

Side Effects and Safety

While the risk profiles for both Tysabri and Novantrone are totally different, they both induce an initial negative or fear response in many people – Tysabri has the history of PML and Novantrone is chemotherapy. Here is the condensed version – Novantrone is likely to make you feel kind of yucky after the infusion for a couple of days, with things like vomiting/nausea, increased risk of bladder and respiratory tract infections, and, well, you might lose some of your hair. On Tysabri, you probably won’t feel quite as gross in the days following the infusion, as the most common side effects are infusion-site reactions, fatigue, headaches and joint pain. The deciding factor for many people may come down to choosing between the (1.2 per 10,000) risk of PML with Tysabri versus the risk of leukemia (7.4 per 1,000) or cardiac damage with Novantrone.


Tysabri is administered intravenously (by IV in an infusion center or in your doctor’s office) once a month. Novantrone is administered intravenously every 3 months.

Long-Term Use

Tysabri (at this point in time) can be used indefinitely, although the safety of the drug after 2 years of use is unknown. Novantrone, on the other hand, can only be used for up to two to three years (10 or 11 doses total) in a patient’s lifetime.


The effectiveness of the drugs seem to be pretty similar, but hard to compare directly, due to differences in study design. In a 2-year study, compared to a placebo, Novantrone has been shown to reduce the number of relapses, lengthen the time between relapses, show a 61 percent reduction in the deterioration of study participants’ ability to walk and significantly less neurological disability. Tysabri has demonstrated a 68% reduction in relapses over two years, as well as slowing the progression of disability and reducing the number of new relapses.

Pregnancy (Current and Future) and Breastfeeding

Women who are pregnant or trying to conceive should not take either Tysabri or Novantrone, nor should either be used by women who are breastfeeding. Tysabri is considered to be in "pregnancy category C," meaning that it caused some harm to fetuses in animal studies but the effect in humans is unknown. Tysabri should be stopped for some time before trying to conceive (usually one to three months; discuss this with your doctor). Novantrone is considered to be in “pregnancy category Category D,” meaning it can cause fetal harm when administered to a pregnant woman. Women of childbearing age require pregnancy tests before receiving each dose of Novantrone.

IMPORTANT NOTE: Some women (5-30%) completing a full course of Novantrone never start their periods again and are sterile (unable to get pregnant). It is extremely important to consider this possibility when deciding whether or not to use Novantrone and to discuss it with your husband or partner. Recent studies demonstrate that the chance of female sterility can be lessened by the use of hormone treatment (estroprogestinic drugs) during treatment with Novantrone and this should be discussed with your doctor.


Solu-Medrol, the intravenous corticosteroid that is used to shorten the duration and severity of relapses, is generally not recommended for people who are using Tysabri for at least a month before or after the last infusion, due to increased immunosuppression, although there are some doctors that will prescribe it in the case of a relapse and I have heard of moderate doses (125 to 500 mg) given at the same time as a Tysabri infusion to help with minor allergic reactions to the Tysabri. On the other hand, Solu-Medrol is often given at the same time as the Novantrone infusion and can be freely given in the case of a relapse between Novantrone infusions.


Before starting Novantrone, you will take the following tests: blood tests (CBC, liver function, pregnancy for women), electrocardiogram (EKG), and an echocardiogram as a baseline evaluation of left ventricular ejection fraction (LVEF) should be performed before every dose of Novantrone. Novantrone treatment should be discontinued if LVEF changes significantly or is ever under 50%. All the tests will be repeated before each treatment. Tysabri can only be given at an infusion center that is registered through the "TOUCH" program. "TOUCH" stands for "Tysabri Outreach: Unified Commitment to Health" and is the program that was put in place in an attempt to catch any potential cases of PML in early stages, as well as prevent them. You will be examined by a doctor or nurse and get an MRI before starting Tysabri, then examined every 3 to 6 months for neurologic changes. You will be asked to review patient safety information and fill out a short survey before each infusion.


Novantrone should not be used by people with heart disease or taking other medications that can damage the heart, liver problems, low red and white blood counts, blood clotting problems, cancer or a history of past cancer treatments. Tysabri should not be taken by people that are taking immunosuppressants or immunomodulators or by people with compromised immune systems. Neither drug should be taken by people with current infections.


Tysabri is one of the most expensive MS treatments available, at $28,400 a year for Tysabri itself. Novantrone costs about $3,000 a year for the medication, making it the least expensive. Both come with additional costs for the infusion center.

Bottom Line

The decision to use Tysabri or Novantrone is a very personal one, which may be either simple or complicated, depending on which factors you focus on or that apply to you (for example, someone who has to pay out of pocket may find Novantrone much more appealing, while a young woman who wants children in the future may lean strongly toward Tysabri). If your doctor has a very strong opinion one way or another, make sure that you ask him or her to explain the reasons. Always feel free to get another opinion if you are still not convinced. It could be that your doctor doesn’t have access to Tysabri – if you want it, find another doctor that does and ask his opinion. Conversely, it could be that your doctor is uncomfortable using chemotherapy drugs, but there are many other doctors that have used Novantrone in hundreds of patients with great results. Keep searching for answers until you are satisfied.

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