Fingolimod tedavisinin multipl skleroz hastalarında karaciğer enzim düzeylerine etkisi
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Dosyalar
Tarih
2019
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Multipl skleroz (MS) enflamasyon, demiyelinizasyon ve nörodejenerasyon ile karakterize otoimmün bir merkezi sinir sistemi (MSS) hastalığıdır. Hastalığın inflamatuvar fazı için birçok ilaç üretilmiştir. Bu ilaçlardan biri de fingolimoddur. Fingolimod, lenf düğümlerinden lenfosit çıkışını inhibe eden, oto-reaktif T ve B lenfositlerin MSS'ye geçişini engelleyen bir sfingosin 1-fosfat reseptör (S1PR) modülatörüdür. Relapsing remittng MS (RRMS) hastalarında yapılan çalışmalar, fingolimod tedavisinin nöroinflamatuar hastalığı azaltabildiğini ve MSS doku bütünlüğünü geliştirdiğini göstermiştir. Fingolimodun, terapötik etkilerinin yanında çeşitli yan etkiler de bildirilmiştir. Bunların arasında karaciğer enzim düzeylerine olan etkisi dikkat çekmektedir. Çalışmamızda Hatay Mustafa Kemal Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı MS polikliniğinde RRMS tanısı ile takip edilen ve ilk kez fingolimod tedavisi başlanan hastalarda fingolimod tedavisinin, karaciğer enzimlerine etkisinin araştırılması amaçlandı. Çalışmamız retrospektif bir çalışma olup, hastanemiz poliklinik veritabanına kayıtlı MS hastalarından 102 RRMS hastasına ait, cinsiyet, yaş, fingolimod kullanım süresi ve karaciğer enzim düzeyleri (Alanin aminotransferaz (ALT), Gama glutamil transpeptidaz (GGT)) kaydedildi ve istatistiksel olarak değerlendirildi. Çalışmamızda, RRMS hastalarında 0,5 mg/gün dozunda oral fingolimod tedavisi başlandıktan en erken 3 ay sonrasında bakılan ALT ve GGT düzeylerinin, tedaviye başlanmadan önceki ALT ve GGT düzeylerine göre anlamlı derecede yüksek olduğu saptandı (p<0,001). Erkek hastalarda tedavi sonrası ortalama ALT ve GGT düzeyleri kadın hastalara kıyasla yaklaşık iki kat yüksek bulundu. Erkek hastaların %23,4'ünün ve kadın hastaların %17,9'unun ALT düzeylerinin normalin üst sınırını geçtiği, erkek hastaların %34,6'sının ve kadın hastaların ise %32,6'sının GGT düzeylerinin normalin üst sınırını geçtiği saptandı. Karaciğer enzim yükselmesi ile hasta yaşı ve fingolimod kullanım süresi arasında korelasyon bulunmadı.
Multiple sclerosis (MS) is an autoimmune central nervous system (CNS) disease characterized by inflammation, demyelination and neurodegeneration. One of these drugs is fingolimod. Fingolimod is a sphingosine 1-phosphate receptor (S1PR) modulator that inhibits lymphocyte output from lymph nodes and prevents the passage of auto-reactive T and B lymphocytes into the central nervous system (CNS). Studies in patients with relapsing remittng MS (RRMS) have shown that fingolimod treatment can reduce neuroinflammatory disease and improve central nervous system tissue integrity. In addition to the therapeutic effects of phenololodod, various side effects have also been reported of which, effect on liver enzyme levels is notable. The aim of this study was to investigate the effect of fingolimod treatment on liver enzymes in patients who were followed-up with RRMS diagnosis and were treated with fingolimod for the first time in the MS outpatient clinic of Neurology of Medical Faculty at Department Hatay Mustafa Kemal University. Our study was a retrospective study, and sex, age, fingolimod usage period and liver enzyme levels (Alanine aminotransferase (ALT), Gamma glutamyl transpeptidase (GGT)) of 102 RRMS patients from MS patients enrolled in the polyclinic database of the hospital were recorded and were statistically evaluated. In our study, ALT and GGT levels recorded at least 3 months after starting oral finglimod (0,5mg/day) treatment in RRMS patients were found to be significantly higher than the ones before starting any treatment (p <0.001). Mean ALT and GGT levels after fingolimod treatment were approximately two times higher in male patients than in female patients. It was found that 23.4% of male patients and 17,9% of female patients exceeded the upper limit of normal ALT levels and 34.6% of male patients and 32.6% of female patients exceeded upper limitof normal GGT levels. There was no correlation between liver enzyme elevation and patient age and fingolimod usage period.
Multiple sclerosis (MS) is an autoimmune central nervous system (CNS) disease characterized by inflammation, demyelination and neurodegeneration. One of these drugs is fingolimod. Fingolimod is a sphingosine 1-phosphate receptor (S1PR) modulator that inhibits lymphocyte output from lymph nodes and prevents the passage of auto-reactive T and B lymphocytes into the central nervous system (CNS). Studies in patients with relapsing remittng MS (RRMS) have shown that fingolimod treatment can reduce neuroinflammatory disease and improve central nervous system tissue integrity. In addition to the therapeutic effects of phenololodod, various side effects have also been reported of which, effect on liver enzyme levels is notable. The aim of this study was to investigate the effect of fingolimod treatment on liver enzymes in patients who were followed-up with RRMS diagnosis and were treated with fingolimod for the first time in the MS outpatient clinic of Neurology of Medical Faculty at Department Hatay Mustafa Kemal University. Our study was a retrospective study, and sex, age, fingolimod usage period and liver enzyme levels (Alanine aminotransferase (ALT), Gamma glutamyl transpeptidase (GGT)) of 102 RRMS patients from MS patients enrolled in the polyclinic database of the hospital were recorded and were statistically evaluated. In our study, ALT and GGT levels recorded at least 3 months after starting oral finglimod (0,5mg/day) treatment in RRMS patients were found to be significantly higher than the ones before starting any treatment (p <0.001). Mean ALT and GGT levels after fingolimod treatment were approximately two times higher in male patients than in female patients. It was found that 23.4% of male patients and 17,9% of female patients exceeded the upper limit of normal ALT levels and 34.6% of male patients and 32.6% of female patients exceeded upper limitof normal GGT levels. There was no correlation between liver enzyme elevation and patient age and fingolimod usage period.
Açıklama
Anahtar Kelimeler
Tıbbi Biyoloji, Medical Biology, Fingolimod, multipl skleroz, relapsing remitting multipl skleroz, alanin aminotransferaz, gama glutamil transpeptidaz., Fingolimod, multiple sclerosis, relapsing remitting multiple sclerosis, alanine aminotransferase, gamma glutamyl transpeptidase.
