Browsing by Author "Aksu, K"

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    Economic burden of short-acting beta-2 agonist (SABA) overuse among asthma patients in Türkiye: a cost analysis with respect to the updated GINA treatment recommendations
    Yorgancioglu, A; Aksu, K; Cura, C; Yaman, Y; Dinç, M; Malhan, S
    BackgroundThis cost of illness study aimed to determine economic burden of short-acting beta 2-agonist (SABA) overuse in T & uuml;rkiye from payer perspective with respect to the updated GINA 2022 treatment recommendations.MethodsA total of 3,034,879 asthma patients comprised the study population, via estimations extrapolated from the T & uuml;rkiye arm of the global SABINA III study. The economic burden (costs related to the drug use and severe exacerbations) was compared in subgroups of overall (>= 0 canisters/year) vs. GINA-recommended (0-2 canisters/year, hypothetical population) SABA use and in subgroups of appropriate use (0-2 canisters/year, real population) vs. overuse (>= 3 canisters/year) of SABA with extrapolation of SABINA T & uuml;rkiye data to the T & uuml;rkiye asthma population.ResultsRecommended SABA use was predicted to prevent 127,505 of 157,512 severe exacerbations per year in mild asthma patients and 2,668,916 of 3,262,800 severe exacerbations per year in moderate-severe asthma patients. Annual cost burden of not applying recommended SABA use (overall [>= 0 canisters/year] vs. GINA-recommended [0-2 canisters/year] SABA use) in mild asthma and moderate-severe asthma patients was calculated to be 20.43 million and 427.65 million in terms of severe exacerbations, and to be 829,352 and 7.20 million in terms of drug costs, respectively. The total annual economic burden arising from not applying recommended SABA use was estimated to be 456.11 million. Appropriate use (0-2 canisters/year) vs. overuse (>= 3 canisters/year) of SABA was associated with decreased frequency of severe exacerbations per year in mild asthma (from 129,878 to 27,634) and moderate-severe asthma (from 2,834,611 to 428,189) patients. SABA overuse in mild and moderate-severe asthma patients was estimated to yield an additional annual cost of 16.38 million and 385.59 million, respectively in terms of severe exacerbations, and a total 11.30 million additional drug cost. The overall annual economic burden arising from SABA overuse was estimated to be 413.27 million.ConclusionsThe estimated annual total economic burden arising from not applying recommended SABA use (456.11 million) and SABA overuse (413.27 million) with respect to the updated GINA 2022 treatment recommendations indicates the substantial cost burden of SABA overuse to the Turkish National Health System, corresponding up to 26% of the total direct cost of asthma reported in our country.
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    Comparison of 18F-FDG PET/CT findings with current clinical disease status in patients with Takayasu's arteritis
    Karapolat, I; Kalfa, M; Keser, G; Yalçin, M; Inal, V; Kumanlioglu, K; Pirildar, T; Aksu, K
    Objective. 18F-fluorodeoxyglucosepositron emission tomography/computed tomography (18F-FDG PET/CT) scanning has been proposed as a new tool to assess disease activity in Takayasu arteritis (TA). We investigated whether 18F-FDG PET/CT findings were consistent with current clinical disease status in patients with TA. Methods. In this cross sectional study, 22 patients with TA were enrolled. Clinical disease activity was assessed by the combination of National Institutes of Health (NIH) criteria, Disease Extent Index-Takayasu (DEI-Tak) score, physician global assessment and 18F-FDG PET/CT scans. Results. At the time 18F-FDG PET/CT scans were taken, the majority of the patients (17122) were using immunosuppressive (IS) drugs, and only four patients had clinically active disease. 18F-FDG PET/CT scans confirmed the presence of active vasculitic lesions in those four patients. In 16 out of 18 patients who were accepted to be in clinical remission, 18F-FDG PET/CT scans were also normal. There were only two patients with discordant results, i.e. active 18F-FDG PET/CT findings despite the lack of clinical activity. Interestingly, clinical exacerbation occurred four weeks later in one of them. Overall sensitivity and specificity of 18F-FDG PET/CT findings for clinical activity were 100% and 88.9%, respectively. Conclusion. We found that 18F-FDG PET/CT findings were generally consistent with clinical disease status in TA. Although use of IS drugs certainly impairs diagnostic accuracy of 18F-FDG PET/CT in TA, this imaging method may still have a potential for confirming remission or detecting disease activity in patients with TA receiving treatment.
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    Levels in patients with Behcet's disease
    Tunç, E; Arslan, Ç; Sahin, M; Sutcu, R; Aksu, K; Pirildar, T
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    Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study
    Ortiz-Fernández, L; Saruhan-Direskeneli, G; Alibaz-Oner, F; Kaymaz-Tahra, S; Coit, P; Kong, XF; Kiprianos, AP; Maughan, RT; Aydin, SZ; Aksu, K; Keser, G; Kamali, S; Inanc, M; Springer, J; Akar, S; Onen, F; Akkoc, N; Khalidi, NA; Koening, C; Karadag, O; Kiraz, S; Forbess, L; Langford, CA; McAlear, CA; Ozbalkan, Z; Yavuz, S; Çetin, GY; Alpay-Kanitez, N; Chung, S; Ates, A; Karaaslan, Y; McKinnon-Maksimowicz, K; Monach, PA; Ozer, HTE; Seyahi, E; Fresko, I; Cefle, A; Seo, P; Warrington, KJ; Ozturk, MA; Ytterberg, SR; Cobankara, V; Onat, AM; Duzgun, N; Bicakcigil, M; Yentür, SP; Lally, L; Manfredi, AA; Baldissera, E; Erken, E; Yazici, A; Kisacik, B; Kasifoglu, T; Dalkilic, E; Cuthbertson, D; Pagnoux, C; Sreih, A; Reales, G; Wallace, C; Wren, JD; Cunninghame-Graham, DS; Vyse, TJ; Sun, Y; Chen, HY; Grayson, PC; Tombetti, E; Jiang, LD; Mason, JC; Merkel, PA; Direskeneli, H; Sawalha, AH
    Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 x 10(-s)) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.
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    Short-acting β2-agonist prescription patterns in patients with asthma in Turkey: results from SABINA III
    Yorgancioglu, A; Aksu, K; Nayci, SA; Ediger, D; Mungan, D; Gül, U; Beekman, MJHI
    Background: Over-reliance on short-acting beta(2)-agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study. Methods: This observational, cross-sectional study included patients aged >= 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit. Results: Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3-5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced >= 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed >= 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving >= 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting beta-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased >= 3 canisters in the preceding 12 months. Conclusions: Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for >= 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations.
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    Overprescription of short-acting β2-agonists is associated with poor asthma symptom control: results from five Middle Eastern countries included in the SABINA International (III) study
    Al Zaabi, A; Busaidi, N; Al Mutairy, S; Yorgancioglu, A; Aksu, K; Al-Jahdali, H; Wali, S; Elsayed, M; Beekman, MJ
    Background: Although short-acting beta(2)-agonist (SABA) overuse is associated with poor treatment outcomes, data on SABA use in the Middle East are lacking. Research design and methods: In this cross-sectional study in patients (aged >= 12 years) with asthma, data on disease characteristics and asthma treatments were collected from the Middle Eastern cohort of the SABA use IN Asthma (SABINA) III study. Patients were classified by investigator-defined asthma severity and practice type. Multivariable regression models analyzed the association between SABA prescriptions and clinical outcomes. Results: Of 1389 patients (mean age, 46.7 years; female, 69.5%), 85.7% had moderate-to-severe asthma and 88.7% were treated by specialists. Overall, 51.3% of patients experienced >= 1 severe asthma exacerbation in the previous 12 months, with 58.2% having partly controlled or uncontrolled asthma. Notably, 47.1% of patients were prescribed >= 3 SABA canisters (considered overprescription). SABA canisters were purchased over the counter by 15.3% of patients. Higher SABA prescriptions (vs 1-2 canisters), except 3-5 canisters, were associated with increased odds of uncontrolled asthma (p < 0.05). Conclusions: SABA overprescription occurred in almost half of all patients in the Middle East, underscoring the need for healthcare providers and policymakers to adhere to the latest evidence-based recommendations to address this public health concern. Plain Language Summary Asthma is a long-term disease that causes inflammation of the airways in the lungs and affects both adults and children. Despite effective medicines, asthma remains poorly controlled in many patients. Inhaled steroids with anti-inflammatory properties are the most effective controller medications for asthma. However, many patients rely on rescue or reliever medications, including short-acting beta(2)-agonists (SABAs), as they provide immediate relief from symptoms. However, SABAs do not treat the underlying inflammation of asthma and their continued overuse may place patients at risk of asthma attacks and hospitalization. The SABA use IN Asthma study, known as SABINA, examined SABA prescriptions in patients with asthma in 24 countries across five continents. As part of this study, data were collected on prescriptions for asthma medications (including SABA prescriptions) and the purchase of SABA over-the-counter (OTC) at the pharmacy without a prescription from 1389 patients aged at least 12 years across five countries in the Middle East (United Arab Emirates, Kuwait, Oman, Saudi Arabia, and Turkey). Nearly half of all patients were prescribed three or more SABA canisters in the previous 12 months, which is above that recommended by asthma treatment guidelines. SABA was also purchased OTC without a prescription by approximately 15% of patients, a majority of whom had already received a high number of SABA prescriptions. Prescription of six or more SABA canisters was associated with poor asthma control. Therefore, there is an urgent need for healthcare providers to follow the latest treatment guidelines for asthma to reduce SABA prescriptions.
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    Platelet-activating factor and P-selectin activities in thrombotic and nonthrombotic Behcet's patients
    Tunc, SE; Aksu, K; Keser, G; Oksel, F; Doganavsargil, E; Pirildar, T; Turk, T; Terzioglu, E; Huseyinov, A
    Objective: The aim of this study was to compare plasma Platelet-activating factor (PAF) and P-selectin (CD62P) activities in Behcet's disease patients with and without thrombosis. Methods: In this cross-sectional and descriptive study, 30 consecutive Behcet's patients were included, 15 of them with venous thrombosis. All patients were also divided into two subgroups according to the presence or absence of clinical activity. Plasma PAF levels, basal and Ca++ ionophore (A23187)-induced leukocyte (cellular) PAF activities, and platelet-rich plasma Delta CD62P activity (the mean fluorescent density difference between CD62P phycoerythrin-positive and -negative stains) were evaluated. Results: In the thrombotic group, plasma PAF (P=0.001), basal leukocyte PAF (P=0.017), induced leukocyte PAF (P=0.024), and Delta CD62P (P=0.023) levels were significantly higher than in the nonthrombotic group. In the whole group of Behcet's patients, there was a positive correlation between plasma PAF and Delta CD62P levels (r=0.533, P=0.002). When we compared clinically active and inactive patients with respect to the above parameters, there was no significant difference, irrespective of thrombosis. Plasma PAF (P=0.001), basal leukocyte PAF (P=0.004), and Delta CD62P (P=0.038) levels were significantly higher in the presence of both clinical activity and thrombosis than of clinical activity alone. Conclusion: Platelet-activating factor and CD62P may contribute to endothelial injury and thrombosis development in Behcet's disease. These two parameters seem related to the presence of thrombosis rather than clinical activity.