Biological therapy for ocular Behçet's disease with off-label drug prescription in Turkey.

OBJECTIVE: The use of biological agents in the treatment of ocular Behçet's disease has recently become more frequent. The use of two agents, infliximab (IFX) and adalimumab (ADA), for the treatment of Behçet's disease requires prior approval by the Turkish Medicines and Medical Devices Agency. We report on a review of such applications with a view to informing on how such agents are used off-label in Turkey. METHODS: Prescriptions for off-label use of IFX or ADA sent from hospitals in Turkey to the Turkish Medicines and Medical Devices Agency in 2018 were evaluated. Demographic data, previous treatment regimens and reasons for referral were extracted from the files of the cases. RESULTS: A total of 662 patients were considered for off-label use of IFX or ADA for the treatment of ocular Behçet's disease. The mean age of the patients was 35.7±10.8 years (range 12-76); 61.5% of patients were men and 38.5% were women. Of the applications, 345 (52.1%) were for IFX and 317 (47.9%) for ADA. Among the referring hospitals, the public university hospitals ranked first, accounting for 77.9% of IFX and 88.6% of ADA prescriptions. Most applications were made after the failure of conventional therapy, which included steroids and immunosuppressive agents. CONCLUSION: IFX and ADA are rarely used as initial therapy. Stepwise treatment is still preferred in the treatment of ocular Behçet's disease in Turkey. Our report informs on the management of this difficult-to-treat condition.

Vitamin D deficiency in cancer patients and predictors for screening (D-ONC study).

INTRODUCTION: Vitamin D is a prohormone that is vital for calcium/phosphate balance, bone structure, and physiological functioning. Vitamin D deficiency (VDD) is an important clinical problem worldwide. However, there are no standardized protocols for screening of patients with a diagnosis of cancer. The purpose of this study is to define the prevalence of VDD in cancer patients and establish the predictors of VDD to address a specific group of patient for screening. MATERIAL/METHODS: The study was designed as a retrospective case-control study. The patients cared in the outpatient clinic between December 2016 and May 2018 with a diagnosis of cancer were evaluated. The clinical properties and the 25(OH) D levels were evaluated. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between VDD and clinical parameters. RESULTS: In 2 cancer centers, 706 patients with a diagnosis of cancer were evaluated. Median 25(OH) D level was 12.2 ng/mL (2.1-96.4). VDD was present in 509 (72.0%) of patients. The multivariate analysis of factors associated with VDD showed that female gender (OR: 1.5 [95% CI: 1.05-2.4], P = 0.026), low sun light exposure (OR: 1.4 [95% CI: 1.009-2.1], P = 0.045), being under palliative (OR: 1.5, [95% CI: 1.008-2.4] P = 0.04) or adjuvant setting (OR: 2.6 [95% CI: 1.3-5.1], P = 0.006), and history of gastrointestinal surgery (OR: 1.8, [95% CI: 1.03-3.2] P = 0.03) were associated with VDD. The female patients with headscarf had lower 25(OH) D levels than without group (10.5 ng/mL vs 23.4 ng/mL, P < 0.001) and they had more VDD (77.2% vs 29.4%, P < 0.001). CONCLUSION: Our study concluded that prevalence of VDD is high in cancer patients and female gender, low sun light exposure, being under palliative or adjuvant setting, and history of gastrointestinal surgery are associated with VDD. These parameters should be used for selecting patients for screening.

Diagnostic serum vitamin D level is not a reliable prognostic factor for resectable breast cancer.

AIM: There are inconsistent results about the effects of vitamin D level on breast cancer prognosis. We aimed to investigate the effect of vitamin D levels on the prognosis of resectable breast cancer in a patient group with highly different clothing styles. PATIENTS & METHODS: A total of 186 breast cancer patients were enrolled in the study. RESULTS: Vitamin D level was sufficient, insufficient and deficient in 17.2, 52.2 and 30.6% of patients, respectively. There was a significant relationship between clothing style and serum 25 (OH) D levels. We could not establish any relation between vitamin D level and tumor characteristics or survival. CONCLUSION: Vitamin D supplementation can be more important than diagnostic serum vitamin D level on prognosis of breast cancer.