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    Definition and prevalence over the years of polypharmacy in Turkey: A systematic review
    (Marmara Univ, 2023) Goncuoglu, Cansu; Ozdemir, Nesligul; Kara, Emre; Bayraktar-Ekincioglu, Aygin
    Identification of the trend of polypharmacy over the years is as valuable as determining the common definitions for taking precautions. The aim of this systematic review is to reveal the frequency, commonly used definitions and its change over the years of polypharmacy in Turkey. The reporting of this systematic review follows to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist. The MEDLINE and ULAKBIM TR Dizin databases were searched for relevant studies published until April, 2021. The studies conducted with patients >18 years in Turkey were included. A total of 361 articles were identified and 52 articles met the inclusion criteria. The most common definition of polypharmacy was 'combination of 5 or more drugs', followed by the definitions of 'two or more drugs' to '10 or more drugs; and its prevalence ranged between 9% and 95% in the studies. It was determined that the most commonly used definition of polypharmacy was 'the use of 5 or more drugs'. The prevalence of polypharmacy in Turkey was appeared in a wide range and found higher than the studies in the literature. The prevalence and trends of polypharmacy over the years should be carefully observed, inappropriate use of medicines should be examined and necessary precautions should be taken accordingly.
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    Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE)
    (Tubitak Scientific & Technological Research Council Turkey, 2023) Tuncer, Asli; Kurtuncu, Murat; Terzi, Murat; Uygunoglu, Ugur; Goncuoglu, Cansu; Yuceyar, Ayse Nur; Ekmekci, Ozgul
    Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs.Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and alter the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch.Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group.Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.