Investigation of the Effect of Vitamin D On Multiple Sclerosis Patients Using Fingolimod

Öz

Multiple Sclerosis (MS) is a chronic, inflammatory, and neurodegenerative disease of the central nervous system that begins in young adulthood. MS is the leading cause of non-traumatic disability in young adults. Vitamin D is known to have immunomodulatory properties, and its deficiency has been identified as an environmental risk factor for the development of MS and has been associated with disease activation. This study aimed to determine the effects of initial vitamin D levels and replacement on clinical and radiological outcome parameters of patients with MS diagnosed with fingolimod treatment. The medical records of 214 patients we followed up in our center for eight years were evaluated retrospectively. Vitamin level data were analyzed in 132 patients for pretreatment, 130 during treatment, and 98 for replacement therapy. Endpoints were radiological activation, annual attack rate, new attack, progression in EDSS, and no evidence of disease activity-3 (NEDA-3). No correlation was found between the initial vitamin D levels and clinical or radiological activation or progression of the disease in patients receiving fingolimod therapy. In patients with low vitamin levels, no difference was found in the outcome parameters of patients whose replacement therapy could not reach the desired values. No positive difference was observed when the subgroup with high disease activation was evaluated. In conclusion, no correlation was found between initial low serum vitamin D level or inadequate replacement and clinical and radiological worsening. However, there is a need for more comprehensive studies in which other risk factors and genetic polymorphisms specific to the Turkish population are evaluated.

Anahtar Kelimeler

• multiple sclerosis
• vitamin D
• therapeutic treatment
• fingolimod

D Vitamininin Fingolimod Tedavisi Alan Multipl Skleroz Hastaları Üzerine Etkisinin Araştırılması

Öz

Multipl skleroz (MS), genç erişkin yaşta başlayan merkezi sinir sisteminin kronik, inflamatuar ve nörodejeneratif bir hastalığıdır. MS genç yetişkinlerde travmatik olmayan sakatlığın önde gelen nedenidir. D vitamininin immünomodülatör özelliklere sahip olduğu bilinmektedir. Eksikliği MS gelişimi için çevresel bir risk faktörü olarak tanımlanmakta ve hastalık aktivasyonu ile ilişkilendirilmektedir. Bu çalışmanın amacı fingolimod tedavisi alan MS tanılı hastalarda başlangıç vitamin D düzeyleri ve replasman tedavisi ile hastalığın klinik ve radyolojik sonlanımı arasındaki ilişkiyi belirlemektir. 2015-2023 tarihleri arasında merkezimizde takip ettiğimiz 214 hastanın tıbbi kayıtları retrospektif değerlendirildi. Vitamin D düzeyi verileri tedavi öncesi için 132 ve replasman tedavisi için 98 hastada analiz edildi. Sonlanım parametreleri; radyolojik aktivasyon, yıllık atak oranı, yeni atak gelişmesi, Genişletilmiş Özürlülük Durum Ölçeği (EDSS)’nde progresyon ve hastalık aktivitesine dair kanıtın olmaması-3 (NEDA-3) olarak belirlendi. Fingolimod tedavisi başlangıcında vitamin D düzeyleri ile hastalığın klinik veya radyolojik aktivasyonu veya progresyonu ile herhangi bir ilişki saptanmadı. Vitamin düzeyi düşük olan hastalarda replasman tedavisi ile >30 μg/L sağlanamayan hastalarda belirlenen sonlanım parametlerinde farklılık saptanmadı. Yüksek hastalık aktivasyonu olan alt grup değerlendirildiğinde de olumlu yönde herhangi bir fark ve değişim gözlemlenmedi. Sonuç olarak başlangıçtaki düşük serum vitamin D düzeyi veya yetersiz replasmanı ile klinik ve radyolojik kötüleşme arasında ilişki saptanmadı. Ancak sonuçları etkileyebilecek diğer risk faktörlerinin ve türk popülasyonuna özgü genetik polimorfizmlerin de değerlendirildiği daha geniş kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• multipl skleroz
• vitamin D
• terapötik tedavi
• fingolimod

Kaynakça

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