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Öğe Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2023) Terzi, Murat; Helvaci, Elif Merve; Sen, Sedat; Boz, Cavit; Cilingir, Vedat; Akcali, Aylin; Beckmann, YesimIntroduction: Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey. Method: The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12th and 24th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant. Results: A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occured. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia. Conclusion: The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient.Öğe Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment (vol 60, pg 23, 2023)(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2023) Terzi, Murat; Helvaci, Elif Merve; Sen, Sedat; Boz, Cavit; Cilingir, Vedat; Akcali, Aylin; Beckmann, Yesim[Abstract Not Available]Öğe The comparative effectiveness of fingolimod, natalizumab, and ocrelizumab in relapsing-remitting multiple sclerosis(Springer-Verlag Italia Srl, 2023) Boz, Cavit; Ozakbas, Serkan; Terzi, Murat; Karabudak, Rana; Sevim, Serhan; Turkoglu, Recai; Soysal, AysunBackgroundFingolimod, natalizumab, and ocrelizumab are commonly used in the second-line treatment of relapsing-remitting multiple sclerosis (RRMS). However, these have only been compared in observational studies, not in controlled trials, with limited and inconclusive results being reported. A comparison of their effect on relapse and disability in a real-world setting is therefore needed.ObjectivesThe objective of this study was to compare the efficacy of fingolimod, natalizumab, and ocrelizumab in reducing disease activity in RRMS.MethodsThis multicenter, retrospective observational study was carried out with prospectively collected data from 16 centers. All consecutive RRMS patients treated with fingolimod, natalizumab, and ocrelizumab were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores, and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), time to first relapse, and disability accumulation were compared.ResultsPropensity score matching retained 736 patients in the fingolimod versus 370 in the natalizumab groups, 762 in the fingolimod versus 434 in the ocrelizumab groups, and 310 in the natalizumab versus 310 in the ocrelizumab groups for final analyses. Mean ARR decreased markedly from baseline after treatment in all three treatment groups. Mean on-treatment ARR was lower in natalizumab-treated patients (0.09, 95% confidence interval (CI), 0.07-0.12) than in those treated with fingolimod (0.17, 0.15-0.19, p<0.001), ocrelizumab (0.08, 0.06-0.11), and fingolimod (0.14, 0.12-0.16, p=0.001). No significant difference was observed in mean on-treatment ARR between patients treated with natalizumab (0.08, 0.06-0.11) and ocrelizumab (0.09, 0.07-0.12, p=0.54). Compared to fingolimod, the natalizumab and ocrelizumab groups exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients at year 1. No significance differences in disability accumulation were determined between the therapies.ConclusionNatalizumab and ocrelizumab exhibited similar effects on relapse control, and both were associated with better relapse control than fingolimod. The effects of the three therapies on disability outcomes were similar.Öğe General Approach to Diagnosis and Treatment of Multiple Sclerosis in Turkey(Turkish Neurological Soc, 2009) Terzi, Murat; Celik, Yahya; Kilinc, Munire; Seleker, Feray; Isik, Nihal; Gedizlioglu, Muhtesem; Zorlu, YasarObjective: The clinical progress of multiple sclerosis (MS), initial symptoms and problems during the course of a disease that can be seen, may vary among the patients. Therefore, different applications occurs in the disease diagnosis and treatment plan. The difficulties of diagnosis, treatment and progress of MS disease, experienced by the neurology residents and experts from different regions of the Turkey is intended to introduce. Materials and Methods: Interactive meetings was arrenged in total 11 cities from different regions of Turkey, between March 2008 and June 2008. The data obtained as a result of the responses of participants were evaluated. Results: Neurology specialist and research assistant, total of 242 persons participated. It was observed that 14 percent of visual evoked potential, 40 percent of cerebrospinal fluid (CSF) oligoclonal band review and one percent of magnetic resonance imaging examinations used in diagnosis of MS can't be done. There was significant differences between regions about feasibility of CSF OCB. Sixty one percent of participants thought to start immunomodulatory treatment to typical relapsing-remitting multiple sclerosis patients, filled in the Mc Donald diagnostic criteria and had two attack story. Conclusion: As all the world, in Turkey being very much difference about clinical, radiological and laboratory features of MS lead to the neurology experts work hard and the emergence of different applications about the disease diagnosis and treatment plan.Öğe Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder Patients in Turkish Cohort Demographic, Clinical, and Laboratory Features(Lippincott Williams & Wilkins, 2015) Altintas, Ayse; Karabudak, Rana; Balci, Belgin P.; Terzi, Murat; Soysal, Aysun; Saip, Sabahattin; Kurne, Asli TuncerBackground: Neuromyelitis optica (NMO) is an immune-mediated, chronic relapsing, inflammatory disease characterized by severe attacks of optic neuritis and myelitis. Objective: To determine the demographic, clinical, and laboratory features; antibody status; and treatment modalities of patients with NMO and neuromyelitis optica spectrum disorders in a Turkish cohort from 11 centers. Methods: A total of 182 patients were included in this study. Data on age at disease onset, sex, type of attacks, clinical presentation, analysis of cerebrospinal fluid, serum antiaquaporin-4 antibody status, annual progression index, and medical and family histories were collected. Results: Mean age was 38.43 +/- 12.40 years (range, 13 to 75 y), and mean age at disease onset was 31.29 +/- 12.40 years (median, 29 y; range, 10 to 74 y). In NMO group, the rate of NMO immunoglobulin (Ig)G positivity was 62.5%. The annual progression index was significantly higher in the longitudinally extending spinal cord lesion. The mean Expanded Disability Status Scale score was higher in the late than early-onset NMO group. Conclusion: Our results revealed a lower rate of NMO IgG positivity, more severe disability in patients with NMO/neuromyelitis optica spectrum disorders presenting with either transverse myelitis or late-onset NMO, and no correlation between disability and NMO IgG status.Öğe Türkiye'de multipl skleroz hastalığının tanı ve tedavisine genel yaklaşım(2009) Terzi, Murat; Çelik, Yayla; Kılınç, Münire; Seleker, Feray; Işık, Nihal; Gedizoğlu, Muhteşem; Zorlu, YaşarAMAÇ: Multipl skleroz (MS)’un klinik seyri, başlangıç semptomları ve hastalığın seyri boyunca görülebilecek problemler, hastalar arasında farklılık gösterebilmektedir. Bu nedenle, hastalığın tanı ve tedavi planında farklı uygulamalar ortaya çıkmaktadır. Türkiye’nin farklı bölgelerindeki nöroloji asistan ve uzmanlarının MS hastalığının tanısında, takibinde, tedavisinde yaşadıkları zorlukların ortaya konması amaçlanmıştır. YÖNTEMLER: Mart 2008-Haziran 2008 tarihleri arasında, Türkiye’nin farklı bölgelerinden toplam 11 ilde interaktif toplantılar düzenlendi. Katılımcıların verdiği cevaplar sonunda elde edilen veriler değerlendirildi. BULGULAR: Toplam 242 nöroloji uzmanı ve araştırma görevlisi katıldı. MS tanısında kullanılan tetkiklerden görsel uyandırılmış potansiyellerin %14, beyin omurilik sıvısı (BOS) oligoklonal band incelemesinin %40, manyetik rezonans görüntülemenin %1 oranında yapılamadığı görüldü. BOS oligoklonal band bakılabilirliği açısından bölgeler arasında anlamlı farklılık vardı. Mc Donald tanı kriterlerini dolduran, iki atak öyküsü olan tipik relapsing-remitting multipl skleroz hastasında katılımcıların %61’i immünmodülatör tedavi başlamayı düşündü. SONUÇ: MS’in klinik, radyolojik ve laboratuvar özellikleri bakımından oldukça fazla farklılığın olması, hastalığın tanı ve tedavi planında, tüm dünyada olduğu gibi Türkiye’de de nöroloji uzmanlarının işini zorlaştırmakta ve farklı uygulamaların ortaya çıkmasına neden olmaktadır.Öğe Use of follow-on fingolimod for multiple sclerosis: Analysis of effectiveness and patient reported outcomes in a real-world clinical setting(Elsevier Sci Ltd, 2023) Altunan, Bengu; Unal, Aysun; Efendi, Husnu; Koseoglu, Mesrure; Terzi, Murat; Kotan, Dilcan; Tamam, YusufBackground: Follow-on disease modifying therapies (FO-DMTs) do not always require Phase III studies. There are concerns that cheaper FO-DMTs are only used to reduce healthcare costs. However, the well-being of people with MS (pwMS) should be a priority. We aimed to evaluate the efficacy, safety and treatment satisfaction of one of the FO-Fingolimod (FTY) used in Turkey with the approval of Turkish Ministry of Health.Methods: PwMS under FTY were recruited from 13 centers and real-world data and answers of satisfaction and adherence statements of pwMS on FTY treatment were analyzed.Results: Data of 239 pwMS were obtained. The duration of FTY treatment was 2.5 & PLUSMN; 0.8 (1-4) years in pwMS who were included in the study and whose treatment continued for at least one year. Significant decreases in annual relapse rate (p < 0.001), Expanded Disability Status Scale (p < 0.001) and neuroimaging findings (p < 0.001) were observed. While 64% of the patients were satisfied and 71.5% were found to adherent with this FO-FTY.Conclusion: This multicenter retrospective study found that the efficacy, safety and treatment adherence of a prescribed FO-FTY were consistent with the results of real-world studies. Studies including real-world data may provide guidance to address issues related to FO-FTY use.
