Browsing by Author "Bavbek, S"
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Item Rapid drug desensitization with platin-based chemotherapy: Analysis of risk factors for breakthrough reactionsAkin, BG; Erkoc, M; Korkmaz, ET; Ozturk, BO; Colak, S; Ates, FSO; Bavbek, SBackground: All platin-based chemotherapeutics can cause hypersensitivity reactions (HSRs). With rapid drug desensitization (RDD), few patients experience breakthrough reactions (BTR) during desensitization. However, data about risk factors for BTRs during RDD in patients with HSRs to platins are limited. We first aimed to describe characteristics of our platin-reactive population and to validate the Brigham and Women's Hospital's (BWH's) RDD protocol in our population along with their outcomes with RDD. Our second aim was to identify the risk factors for BTRs. Method: This was a retrospective chart review (2013-2020) of patients with symptoms of immediate HSRs to platins. Initial HSRs were classified as grade 1, 2, or 3 based on their severity. Skin prick tests (SPT)/intradermal tests (IDT) were performed with implicated platins. A 12-step protocol was used during RDD. Results: The study comprised 65 women and seven men (mean age 57.78 +/- 8.73 years). Initial HSRs to carboplatin, cisplatin, and oxaliplatin occurred in 38, 13, and 21 patients, respectively. All patients reacted at the fifth (median) recurrent infusions (min:1, max:20). The median values for carboplatin, cisplatin, and oxaliplatin were 6 (1-20), 3 (1-15), and 3 (1-11), respectively. Most initial HSRs were grade 2 (n = 40, 55.6%) and 3 (n = 27, 37.5%); only 6.9% (n = 5) were grade 1. Patients with grade 1, 2, and 3 initial HSRs had positive platin skin test results at rates of 80%, 74%, and 88%, respectively. A total of 232 RDDs were performed in 72 patients and 98.7% of these desensitizations were completed. BTRs occurred in 56 (24.1%) (grade 1 n = 14, 25%; grade 2 n = 32, 57%; grade 3 n = 10, 18%) of these desensitizations. Breakthrough reactions were more severe in patients with positive SPTs or 1:100 or 1:10 dilutions of IDT (p = 0.014). BTR was not observed during RDD in any of the patients with positive 1:1 dilutions of IDT. Positivity on prick or 1:100 or 1:10 IDT increased the risk of BTR 5.058 times. There was no significant association between the risk of BTRs and age, drug cycle, sex, comorbidities, or atopy. Conclusion: In our experience, 98.7% of 232 RDDs to platins were completed successfully, showing that RDD was safe and effective. Drug skin test positivity is a potential marker for identifying high-risk patients who will have BTRs during RDDs to platins.Item National safety data of post-marketing use of omalizumab in severe persistent asthma in TurkeyDursun, A; Bavbek, S; Misirligil, Z; Erdener, F; Buyukozturk, S; Aydin, O; Gemicioglu, B; Bayrak, P; Erkekol, FO; Yildirim, Z; Cilli, A; Boz, AB; Alpaydyn, AO; Karakoc, G; Gorguner, M; Karakaya, G; Isik, R; Sapan, N; Bakirtas, AItem Asthma-COPD overlap syndromeSen, E; Oguzülgen, K; Bavbek, S; Günen, H; Kiyan, E; Türktas, H; Yorgancioglu, A; Polatli, M; Yildiz, F; Çelik, G; Demir, T; Gemicioglu, B; Mungan, D; Saryal, S; Sayiner, A; Yildirim, NAsthma and chronic obstructive pulmonary disease (COPD) are common lung diseases characterized by chronic airway inflammation and airway obstruction. Among patient with COPD and asthma; there is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named Asthma-COPD Overlap Syndrome (ACOS). ACOS is a syndrome characterized by reversible but persistant airflow limitation (postbronchodilator FEV1/FVC < 70%) which has some features of both asthma and COPD. ACOS should be suspected in a patient > 40 years, with smoking history, previous asthma diagnosis or history of childhood asthma who has persistant airflow limitation and reversible ariway obstruction (defined by an increase of > % 12 of FEV1 pred or increase of FEV1 > 200 mL after inhalation of 400 mcg salbutamol or 1000 mcg terbutaline). The prevalence for ACOS has been reported 11-55% in different case series to date and increases by age and is more frequent in females in different age groups. Patients with ACOS are younger than COPD patients and older than asthma patients. Frequent and severe exacerbations and related hospitalization and emergency room visits are common in ACOS and this causes an impaired quality of life. Current recommendations of guidelines for pharmacologic treatment of ACOS have been composed of a combination with optimal COPD and asthma treatment. Future therapeutic approaches should be based on endotypes. Clinical phenotype and underlying endotype driven clinical studies may be the base of ACOS guidelines.Item Acute exacerbation in COPD and asthmaYildirim, N; Demir, T; Gemicioglu, B; Kiyan, E; Oguzülgen, K; Polatli, M; Saryal, S; Sayiner, A; Yorgancioglu, A; Bavbek, S; Çelik, GE; Günen, H; Mungan, D; Sen, E; Türktas, H; Yildiz, FChronic obstructive pulmonary disease (COPD) and asthma are airway diseases with acute exacerbations. Natural course of both disease are affected by exacerbations. COPD exacerbations may be caused by infections and other causes; indoor and outdoor pollution, cardiovascular diseases, asthma-COPD overlap syndrome, COPD-obstructive sleep apnea syndrome, pulmonary embolism, gastro-oesophageal reflux, anxiety-depression, pulmonary hypertension. Exposure to triggering factors, viral infections, treatment insufficiency may cause asthma exacerbations. Smoking cessations, prevention of infections, long-acting anticholinergics, long-acting beta 2 agonists, inhaled corticosteroids, phosphodiesterase-4 inhibitors, mucolytics, prophilactic antibiotics can be effective on the prevention of COPD exacerbations. Asthma exacerbations may be decreased by the avoidance of allergens, viral infections, occupational exposures, airpollution, treatment of comorbid diseases. Effective treatment of asthma is required to prevent asthma exacerbations. Inhaled steroids and combined treatments are the most effective preventive therapy for exacerbations. Patient education and cooperation is an element of the preventive measures for asthma attacks. Compliance to therapy, inhalation techniques, written asthma plans are required. The essential of COPD and asthma exacerbation treatment is bronchodilator therapy. Steroids are also implemented to the therapy, targeting the inflammation. Specific treatments of the cause (infection, airpollution, pulmonary embolism etc.) should be administered.Item Stepwise Approach in Asthma Revisited 2023: Expert Panel Opinion of Turkish Guideline of Asthma Diagnosis and Management GroupÇelik, GE; Aydin, Ö; Damadoglu, E; Baççioglu, A; Özdemir, SK; Bavbek, S; Ediger, D; Erkekol, FÖ; Gemicioglu, B; Isik, SR; Kalpaklioglu, AF; Kalyoncu, AF; Karakaya, G; Keren, M; Mungan, D; Oguzülgen, IK; Yildiz, F; Yilmaz, I; Yorgancioglu, AIntroduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma con-trol is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physi-cians to consider the risk factors for poor asthma outcomes, patients' compliance and expectations and then to determine a personalized treatment plan. Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient's risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated.Item Economic burden of severe asthma in Turkey: a cost of illness study from payer perspectiveBavbek, S; Malhan, S; Mungan, D; Misirligil, Z; Erdinc, M; Gemicioglu, B; Oguzulgen, IK; Oksuz, E; Yildiz, F; Yorgancioglu, AObjective. To estimate economic burden of severe asthma in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods. This cost of illness study was based on identification of per patient annual direct medical costs for the management of severe asthma in Take, from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits laboratory and radiological tests, hospitalizations and interventions drug treatment and equipment, and co-morbidities/complications. Results. Based on total annual per patient costs calculated for outpatient admission ($177.91), laboratory and radiological tests ($ 8232), hospitalization/interventions ($1,154.55), drug treatment/equipment ($2,289.63) and co-morbidities ($ 661.39) cost items, total per patient annual direct medical cost related to management of severe asthma was calculated to be $ 4,369.76 from payer perspective. Drug treatment/equipment (524%) was the main cost driver in the management of severe asthma in Turkey, as followed by hospitalizations/interventions (264%) and co-morbidities (15.2%). Conclusions. In conclusion, our findings indicate that managing patients with severe asthma pose a considerable burden to health economics in Turkey with medications as the main cost driver.Item Treatment of Severe Asthma: Expert OpinionTürktas, H; Bavbek, S; Çelik, G; Demir, T; Gemicioglu, B; Günen, H; Kiyan, E; Mungan, D; Oguzulgen, IK; Polatli, M; Saryal, S; Sayiner, A; Sen, E; Yildirim, N; Yildiz, F; Yorgancioglu, ASevere asthmatics account 10% of the all asthmatic population. Those asthmatics whose disease is inadequately controlled account for up to half of the cost for asthma, because they have more emergency room visits, more hospital admission and greater absenteeism from work. New therapeutic options were tried in those patients whose asthma was uncontrolled with standart high dose inhaled corticosteroid and long acting beta-2 agonsit combination therapy. In this paper taking into account the conditions of our country, current literature was reviewed and treatment options was discussed and graded recommendations are made for daily clinical practice in patients with severe treatment-refractory asthma.Item Pregnancy Outcomes of the Asthma Patients on Omalizumab in TurkeyGemicioglu, B; Yalçin, AD; Karakaya, G; Ozdemir, L; Keren, M; Yorgancioglu, AA; Ediger, D; Bavbek, S; Havlucu, Y; Oguzulgen, I; Özseker, ZFItem Country-based report: the safety of omalizumab treatment in pregnant patients with asthmaGemicioglu, B; Yalçin, AD; Havlucu, Y; Karakaya, G; Özdemir, L; Keren, M; Bavbek, S; Ediger, D; Oguzülgen, IK; Özseker, ZF; Yorgancioglu, ABackground/aim: We aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country. Materials and methods: Patients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants. Results: Twenty pregnant patients and their 23 infant's data were analyzed. The mean delivery age was 31.8 +/- 7.4 years. They received omalizumab for 28.9 +/- 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 +/- 18%, 83.4 +/- 10.5%, and 80.5 +/- 13% (FEV1), and 11.9 +/- 4.9, 20.2 +/- 2.6, and 20.4 +/- 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life. Conclusion: Omalizumab treatment during pregnancy seems to be safe for both patients and their infants.