Person: TURAN, ÖMER FARUK
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TURAN
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ÖMER FARUK
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Publication The expression and prognostic value of miR-146a and miR-155 in Turkish patients with multiple sclerosis(Taylor & Francis, 2022-03-04) Sarıdaş, Furkan; Ünlü, Havva Tezcan; Çeçener, Gülşah; Egeli, Ünal; Takanlou, Maryam Sabour; Takanlou, Leila Sabour; Tunca, Berrin; Zarifoğlu, Mehmet; Turan, Ömer Faruk; Taşkapılıoğlu, Özlem; SARIDAŞ, FURKAN; ÇEÇENER, GÜLŞAH; EGELİ, ÜNAL; TUNCA, BERRİN; ZARİFOĞLU, MEHMET; TURAN, ÖMER FARUK; Takanlou, Maryam Sabour; Takanlou, Leila Sabour; Taşkapılıoğlu, Özlem; 0000-0001-5945-2317; 0000-0002-0910-4258; 0000-0002-3820-424X; 0000-0001-7904-883X; 0000-0002-1590-4833; 0000-0002-6361-7150; 0000-0002-1619-6680; HSB-2700-2023; GYU-0252-2022; AAP-9988-2020; AAH-1420-2021; KGL-6846-2024; GRE-6268-2022; ABI-6078-2020; EHN-5825-2022; JDI-6091-2023; EBA-4926-2022Multiple sclerosis (MS) is an inflammatory, autoimmune demyelinating, and neurodegenerative disorder of the central nervous system. Interactions between environmental factors, predisposition genes, and determining genes appear to be involved in its etiology. Epigenetic mechanisms such as microRNA-mediated gene regulation can determine the susceptibility and severity of autoimmune diseases. Therefore, to determine the role of miR-146a and miR-155 in MS and its developmental stages, the expression levels in the serum of MS and clinically isolated syndrome (CIS) patients were compared with those of healthy controls. In the present study, the expression levels of miR-146a and miR-155 were assessed using quantitative Real-Time PCR in blood samples of 15 CIS patients and 61 relapsing-remitting multiple sclerosis (RRMS) patients alongside 32 healthy patients as controls. Furthermore, any associations with the clinicopathologic variables of the patients were also evaluated. Dysregulations were found only in the miR-146a and miR-155 expressions in the RRMS-Control group. When the RRMS patients were evaluated in terms of the characteristics of sex, annual attack rate, age of diagnosis, duration of follow-up, and immunomodulatory treatments used, no significant differences were observed. However, significant dysregulations were identified in miRNA expression in the vitamin D level, EDSS values, and the number of attacks. ROC curve analysis showed that miR-146a and miR-155 were significant in the RRMS-Control group for the area under the curve (AUC). It is possible that miR-146a may be associated with vitamin D deficiency and disease disability, while miR-155 may be associated with the number of attacks.Publication Comparative analysis of fingolimod versus teriflunomide in relapsing-remitting multiple sclerosis(Elsevier Sci Ltd, 2019-11-01) Boz, Cavit; Terzi, Murat; Ozer, Bilge; Türkoğlu, Recai; Karabudak, Rana; Efendi, Hüsnü; Soysal, Aysun; Sevim, Serhan; Altintaş, Ayse; Kurne, Aslı; Akcali, Aylin; Akman, Gülşen; Yüceyar, Nur; Balci, Belgin Petek; Ekmekci, Özgül; Karahan, Serap Zengin; Demirkıran, Meltem; Altunrende, Burcu; Gözübatik Çelik, Gökçen; Kale, Nilüfer; Köseoğlu, Meşrure; Özakbaş, Serkan; Turan, Ömer Faruk; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi; JHM-3244-2023Background: Fingolimod and teriflunomide are commonly used in the treatment of relapsing-remitting multiple sclerosis (RRMS). These have not been compared in controlled trials, but only in observational studies, with inconclusive results. Comparison of their effect on relapse and disability in a real-world setting is therefore needed.Objectives: The objective of this study was to compare the efficacy of fingolimod and teriflunomide in reducing disease activity in RRMS.Methods: This multicenter, retrospective observational study was carried out with prospectively collected data from 15 centers. All consecutive RRMS patients treated with teriflunomide or fingolimod 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), disability accumulation, percentage of patients with active MRI and treatment discontinuation over a median 2.5-year follow-up period were compared.Results: Propensity score matching retained 349 out of 1388 patients in the fingolimod group and 349 out 678 in the teriflunomide group for final analyses. Mean ARR decreased markedly from baseline after 1 and 2 years of treatment in both the fingolimod (0.58-0.17 after 1 year and 0.11 after 2 years, p < 0.001) and teriflunomide (0.56-0.29 after 1 year and 0.31 after 2 years, p < 0.001) groups. Mean ARR was lower in fingolimod-treated patients than in those treated with teriflunomide at years 1 (p = 0.02) and 2 (p = 0.004). Compared to teriflunomide, the fingolimod group exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients after 2.5-year follow-up. Disability worsening was similar between the two groups. Patients were less likely to discontinue fingolimod than teriflunomide (p < 0.001).Conclusion: Fingolimod was associated with a better relapse control and lower discontinuation rate than teriflunomide. The two oral therapies exhibited similar effects on disability outcomes.Publication MS and COVID-19 challenge: Asymptomatic COVID-19 infection during treatment with cladribine(Springer, 2021-06-24) Seferoğlu, Meral; Ethemoğlu, Özlem; Turan, Ömer Faruk; Siva, Aksel; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı; JHM-3244-2023Background The use of disease-modifying therapies (DMTs) in people with multiple sclerosis (pwMS) may affect COVID-19 infection outcomes due to DMTs' immunomodulatory and immunosuppressive effects on immune response. The yet unknown issues are both the early response to the infection, as well as the post-infection development of immunity against the virus under these treatments due to their interaction with the immune system. Methods We report two asymptomatic cases of COVID-19 in patients with relapsing-remitting multiple sclerosis (RRMS) shortly after starting cladribine therapy, both developed anti-SARS-CoV-2 antibody response. Results Patients with MS who are under newly initiated treatment with cladribine tablets may experience an asymptomatic COVID-19 infection and they may develop immunity against SARS-CoV-2. Conclusion These observations raise the probability that DMTs with immunosuppressive effects, such as cladribine, may be considered as a treatment option for selected MS patients with high disease activity during the COVID-19 pandemic.Publication Differences between general neurologists and multiple sclerosis specialists in the management of multiple sclerosis patients: A national survey(Aves, 2019-12-01) Kurtuncu, Murat; Tuncer, Aslı; Uygunoğlu, Uğur; Çalışkan, Zeynep; Kokenli Paksoy, Ayşenur; Efendi, Hüsnü; Sağduyu Kocaman, Ayşe; Özcan, Cemal; Terzi, Murat; Saip, Sabahattin; Karabudak, Rana; Siva, Aksel; Turan, Ömer Faruk; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; JHM-3244-2023Introduction: The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs).Methods: We conducted a survey of 36 questions to 318 neurologists, including 33 MSSs. The survey covered topics including laboratory investigations, pregnancy, and treatment.Results: Our study found many differences between GNs and MSSs in terms of management, the most important being treatment initiation and switching. GNs had a tendency to initiate treatment later than MSSs however, they tended to switch treatment faster. Our study also showed that GNs ordered magnetic resonance imaging (MRI) more frequently than MSSs, even if patients were clinically stable. Moreover, although GNs more frequently relied on MRI, they did not consider brain atrophy as an important measure in the follow-up of their patients. Furthermore, GNs considered replacement therapy less often than MSSs, even in patients with vitamin D deficiency.Discussion: Our study revealed important discrepancies between the management patterns of GNs and MSSs in MS patients. These findings suggest the need for a national education program for GNs on MSSs.Publication Use of natalizumab inn relapsing remitting multiple sclerosis: Experience from a tertiary center in Turkey(Elsevier, 2015-10-15) Turan, Ömer; Taşkapılıoğlu, Özgür; Yıldırım, Öznur; Atasayar, Gülfer; TURAN, ÖMER FARUK; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Yıldırım Öznur; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Bölümü; IIF-2521-2023; GHG-0008-2022; EGW-1652-2022; CEW-6612-2022Publication Efficacy of accelerated vaccination against hbv to achieve antibody formation in multiple sclerosis patients receiving anti-cd20 therapy(Wolters Kluwer Medknow Publications, 2023-09-01) KOÇ, EMİNE RABİA; SARIDAŞ, FURKAN; TURAN, ÖMER FARUK; Turan, Omer Faruk; Özkaya, Güven; ÖZKAYA, GÜVEN; Mengüç, Bedirhan; MENGÜÇ, BEDİRHAN; Minaz, Sema Nur; MİNAZ, SEMA NUR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Bioistatistik Anabilim Dalı.; 0000-0002-0264-7284; 0000-0001-5945-2317; 0000-0003-0297-846X; HSB-2700-2023; JCO-1811-2023Aim:Ocrelizumab is a monoclonal antibody that has been approved for use in both relapsing-remitting multiple sclerosis (RRMS) and primary progressive multiple sclerosis (PPMS). Since ocrelizumab acts on B cells, it also affects humoral immunity, thus reducing the vaccine response. In this study, we aimed to elucidate the relationship between the antibody response following rapid vaccination against hepatitis B virus (HBV) in multiple sclerosis (MS) patients receiving ocrelizumab treatment, and the time of vaccination.Materials and Methods:A total of 220 MS patients were included in this retrospective analysis. The patients' baseline HBV serostatuses (HbsAg, Anti-HbsAb, Anti-HbcAb), previous drug history for MS, whether they were vaccinated against HBV in the past, vaccination status before or after ocrelizumab treatment, and protective antibody titers according to vaccination times, occult HBV incidence and initiation of antiviral treatment were evaluated.Results:Forty-nine percent of MS patients using ocrelizumab were not vaccinated against HBV. The patients were divided into three groups according to their vaccination status as: individuals vaccinated in the past (7.3%, n = 16), vaccinated before treatment (4.5%, n = 10), and vaccinated after treatment (22.3%, n = 49). The antibody titers of the patients in the 6th month after ocrelizumab treatment were measured as 78 mIU/ml, 193 mIU/ml, and 0, respectively. The number of patients with occult HBV infection was 38.Conclusion:In patients with a suspected diagnosis of MS, HBV serostatus should be evaluated at the beginning and if necessary, patients should be vaccinated in the early period. Vaccinating patients at least 1 month before initiating multiple sclerosis treatment is more effective in terms of protective antibody formation.Publication A demographic and polysomnographic investigation of fatigue and sleep disorders in patients with multiple sclerosis(Galenos Yayınevi, 2018-09-01) Sıvacı, Ali Özhan; Demir, Aylin Bican; Turan, Ömer Faruk; Taşkapılıoğlu, Özlem; Bora, İbrahim; Ocakoğlu, Gökhan; Sıvacı, Ali Özhan; BİCAN DEMİR, AYLİN; TURAN, ÖMER FARUK; Taşkapılıoğlu, Özlem; BORA, İBRAHİM HAKKI; OCAKOĞLU, GÖKHAN; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0002-9697-9510; 0000-0001-6739-8605; 0000-0003-4436-3797; 0000-0002-1114-6051; AAK-6623-2020; V-7170-2017; JCE-6657-2023; AAH-5180-2021; HLG-6346-2023; X-4479-2018Objective: To investigate fatigue and sleep disorders based on demographic, clinical and polysomnographic data and show their effects on the quality of life in multiple sclerosis (MS) patients.Materials and Methods: Thirty MS patients were enrolled in the study depending on the results of the polysomnography (PSG), Fatigue Severity scale, Epworth Sleepiness scale (ESS), Pittsburgh Sleep Quality lindex, Beck Depression and Anxiety inventories. Patients, using (n=16) and non-using (n=14) interferon, were compared with each other in all parameters; ESS and PSG data were compared with a control group consisting of 19 healthy people. Short form-36 (SF-36) data were also compared with the society norms.Results: Central fatigue was observed in 86.7% of the patients. PSG data revealed that stage N2 sleep duration of those who did not use interferon was significantly longer than those who used it (p<0.001). According to the PSG, total sleep time, sleep efficiency, stage N3 and rapid eye movement time, mean respiratory disturbance index, sleep latency and the mean value of total leg movements were significantly higher in the patient group than in the control group (p<0.001). All parameters of SF-36 were significantly lower in patient group (p<0.001). The stage N3 sleep time length was found related with physical component summary of SF-36 (p<0.001).Conclusion: MS patients have high level of fatigue and additionally there are weighty disturbances in objective and subjective sleep parameters. Our findings were revealed that all the components of quality of life decreased significantly in these patients. Furthermore, our study showed that deep sleep duration was related with physical activity and emphasized the importance of sleep evaluation in MS patients.Publication Index of cardiac-electrophysiological balance in relapsing-remitting multiple sclerosis patients treated with fingolimod(Elsevier Sci Ltd, 2023-06-16) Günay-Polatkan, S.; GÜNAY POLATKAN, ŞEYDA; SIĞIRLI, DENİZ; Güllü, G.; GÜLLÜ, GİZEM; Sığırlı, Deniz; Koç, E. R.; KOÇ, EMİNE RABİA; Aydınlar, A.; AYDINLAR, ALİ; Turan, O. F.; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0002-0264-7284; A-7083-2015Background: Fingolimod is indicated for the treatment of relapsing-remitting multiple sclerosis (RRMS) and also targets cardiovascular system due to receptors on cardiomyocytes. Results of previous studies are controversial for the effect of fingolimod in terms of ventricular arrhythmias. Index of cardio-electrophysiological balance (iCEB) is a risk marker for predicting malignant ventricular arrhythmia. There is no evidence on the effect of fingolimod on iCEB in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to evaluate iCEB in patients with RRMS treated with fingolimod .Methods: A total of 86 patients with RRMS treated with fingolimod were included in the study. All patients underwent a standard 12-lead surface electrocardiogram at initiation of treatment and 6 h after treatment. Heart rate, RR interval, QRS duration, QT, QTc (heart rate corrected QT), T wave peak-to-end (Tp-e) interval, Tp-e/QT, Tp-e/QTc, iCEB (QT/QRS) and iCEBc (QTc/QRS) ratios were calculated from the electrocardiogram. QT correction for heart rate was performed using both the Bazett and Fridericia formulas. Pre-treatment and posttreatment values were compared.Results: Heart rate was significantly lower after fingolimod treatment (p< 0.001). While the post-treatment values of RR and QT intervals were significantly longer (p< 0.001) and post-treatment iCEB was higher (median [Q1Q3], 4.23 [3.95-4.50] vs 4.53 [4.18-5.14]; p< 0.001), it was found that there was no statistically significant change in iCEB and other study parameters derived using QT after correcting for heart rate using both of two formulas.Conclusions: In this study, it was found that fingolimod did not statistically significantly change any of the heart rate-corrected ventricular repolarization parameters, including iCEBc, and it is safe in terms of ventricular arrhythmia.Publication Teriflunomide and time to clinical multiple sclerosis in patients with radiologically isolated syndrome: The teris randomized clinical trial(Amer Medical Assoc, 2023-08-21) Lebrun-Frenay, Christine; Siva, Aksel; Sormani, Maria Pia; Landes-Chateau, Cassandre; Mondot, Lydiane; Bovis, Francesca; Vermersch, Patrick; Papeix, Caroline; Thouvenot, Eric; Labauge, Pierre; Durand-Dubief, Francoise; Efendi, Husnu; Le Page, Emmanuelle; Terzi, Murat; Derache, Nathalie; Bourre, Bertrand; Hoepner, Robert; Karabudak, Rana; De Seze, Jerome; Ciron, Jonathan; Clavelou, Pierre; Wiertlewski, Sandrine; Yucear, Nur; Cohen, Mikael; Azevedo, Christina; Kantarci, Orhun H.; Okuda, Darin T.; Pelletier, Daniel; Turan, Ömer Faruk; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; JCO-1811-2023Importance Radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS) punctuated by incidental magnetic resonance imaging (MRI) white matter anomalies within the central nervous system.Objective To determine the time to onset of symptoms consistent with MS.Design, Setting, and Participants From September 2017 to October 2022, this multicenter, double-blind, phase 3, randomized clinical trial investigated the efficacy of teriflunomide in delaying MS in individuals with RIS, with a 3-year follow-up. The setting included referral centers in France, Switzerland, and Turkey. Participants older than 18 years meeting 2009 RIS criteria were randomly assigned (1:1) to oral teriflunomide, 14 mg daily, or placebo up to week 96 or, optionally, to week 144.Interventions Clinical, MRI, and patient-reported outcomes (PROs) were collected at baseline and yearly until week 96, with an optional third year in the allocated arm if no symptoms have occurred.Main outcomes Primary analysis was performed in the intention-to-treat population, and safety was assessed accordingly. Secondary end points included MRI outcomes and PROs.Results Among 124 individuals assessed for eligibility, 35 were excluded for declining to participate, not meeting inclusion criteria, or loss of follow-up. Eighty-nine participants (mean [SD] age, 37.8 [12.1] years; 63 female [70.8%]) were enrolled (placebo, 45 [50.6%]; teriflunomide, 44 [49.4%]). Eighteen participants (placebo, 9 [50.0%]; teriflunomide, 9 [50.0%]) discontinued the study, resulting in a dropout rate of 20% for adverse events (3 [16.7%]), consent withdrawal (4 [22.2%]), loss to follow-up (5 [27.8%]), voluntary withdrawal (4 [22.2%]), pregnancy (1 [5.6%]), and study termination (1 [5.6%]). The time to the first clinical event was significantly extended in the teriflunomide arm compared with placebo, in both the unadjusted (hazard ratio [HR], 0.37; 95% CI, 0.16-0.84; P = .02) and adjusted (HR, 0.28; 95% CI, 0.11-0.71; P = .007) analysis. Secondary imaging end point outcomes including the comparison of the cumulative number of new or newly enlarging T2 lesions (rate ratio [RR], 0.57; 95% CI, 0.27-1.20; P = .14), new gadolinium-enhancing lesions (RR, 0.33; 95% CI, 0.09-1.17; P = .09), and the proportion of participants with new lesions (odds ratio, 0.72; 95% CI, 0.25-2.06; P = .54) were not significant.Conclusion and Relevance Treatment with teriflunomide resulted in an unadjusted risk reduction of 63% and an adjusted risk reduction of 72%, relative to placebo, in preventing a first clinical demyelinating event. These data suggest a benefit to early treatment in the MS disease spectrum.