No abstract

No abstract

INTRODUCTIONMultiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS). Its primary characteristics are inflammation and damage to myelin sheaths, oligodendrocytes, axons, and neurons, and it mostly affects young adults. According to global estimates of the Multiple Sclerosis Foundation, more than 2 million people are affected by MS (1,2). Koch-Henriksen and Sørensen performed a large meta-regression analysis from the literature to investigate worldwide changes in demographic patterns of MS incidence and prevalence (2). The prevalence of the disease is higher among Caucasians and the female to male ratio of 2:1 has risen to 4:1 over recent years (3). Its etiology remains obscure; however, MS is believed to be caused through an intricate relationship between infectious agents and genetic and environmental aspects.Multiple sclerosis presents in four forms; the most frequently seen is relapsing-remitting MS (RRMS), which is diagnosed in 85% of patients with MS at onset. RRMS is characterized by more neuroinflammation than neurodegeneration; relapses and the generation of new lesions, which are visible with magnetic resonance imaging (MRI), particularly with contrast-enhancing T1-weighted lesions in particular; and worsening symptoms, followed by periods of stability. Over time, residual disabilities accumulate leading to permanent disability, and approximately 50% of people with untreated RRMS show transition to secondary progressive MS within a decade of the initial diagnosis, which is distinguished by its more extensive neurodegeneration, compared with inflammation (4). The remaining two presentations are primary progressive MS, which has no clear relapses or remissions and is diagnosed in approximately 10% of patients at onset, and progressive-relapsing MS, which affects 5% of patients. Introduction: To assess satisfaction and quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) who were receiving fingolimod (0.5 mg/day) for 12 months as a second-line treatment after switching from injectable agents.

176Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and is characterized by inflammation, demyelination, and axonal loss. Fingolimod is the first oral drug for the treatment of MS approved by the United States Food and Drug Administration, European Union countries, and various other countries. The compound exerts its effect via interaction with lysophospholipid receptors known as sphingosine-1 phosphate receptors. Although fingolimod has a very convenient daily oral dosing, it may cause development of bradycardia at the first dose, macular edema, infection, all of which require attention. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rates and is beneficial in brain magnetic resonance imaging measures when compared with both placebo and intramuscular interferon β-1a. This review describes the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of the management of MS.Keywords: Multiple sclerosis, fingolimod, sphingosine-1 phosphate, efficacy, safety Multipl skleroz (MS) merkezi sinir sisteminin enflamasyon, demiyelinizasyon ve akson kaybı ile karakterize kronik otoimmün, nörodejeneratif bir hastalığıdır. Fingolimod Amerikan İlaç ve Gıda Dairesi ve Avrupa Birliği üyesi ülkelerin de bulunduğu 80'den fazla ülke tarafından onaylanmış ilk oral MS ilacıdır. Bu bileşik, sfingozin-1 fosfat olarak bilinen lizofosfolipid reseptörleri aracılığı ile etkilerini gösterir. Günlük oral yolla kullanımı kolaylık sağlamakla birlikte bazı hastalarda ilk doz sırasında bradikardi gelişmesi, maküler ödem, enfeksiyon gibi bazı dikkat edilmesi gereken durumlar ile karşılaşılabilmektedir. Randomize çift-kör klinik çalışmalar, plasebo ve intramüsküler interferon β-1a tedavilerine kıyasla fingolimodun atak sıklığını anlamlı derecede azalttığını ve beyin manyetik rezonans ölçütleri üzerine yararlı etkiler gösterdiğini ortaya koymuştur. Bu derlemede, fingolimodun klinikte MS hastalarının yönetimindeki etkinliği, güvenliliği ve tolerabilitesi ele alınmıştır.