Comparison of depression, anxiety and quality of life in patients diagnosed with multiple sclerosis using fingolimod and cladribine

AİM: Multiple Sclerosis (MS) is a chronic, degenerative, autoimmune disease of the central nervous system that affects approximately 2 million people worldwide (1). MS causes significant psychosocial and physical disability as it progresses with attacks and remissions and affects the young population. Progressive physical disabilities and the resulting emotional and social problems negatively affect the patient's quality of life (4). Psychiatric disorders occur very frequently in the course of MS. The most common psychiatric disorder in MS is depression, and anxiety is also common (5). The importance of quality of life studies in the care of patients with MS is increasing. While in the past only the visible effects of the disease were evaluated in MS, today the approach to measuring quality of life, which allows the effects of the disease to be evaluated from a broader perspective, is at the forefront (8,9). In this study, we aimed to identify depression, anxiety, fatigue, cognitive and sexual dysfunctions that are often overlooked in patients with MS and whose treatment may be delayed, to determine the quality of life of patients with MS and to evaluate the effect of the Disease Modifying Drugs (DMD) fingolimod and cladribine on depression-anxiety in MS patients. We aimed to determine its effects on quality of life. Material and metods : Participants were selected from patients diagnosed with MS according to the 2017 McDonald's criteria who applied to Dicle University Neurology outpatient clinic. Patients were selected from people between the ages of 18-50, who had been using fingolimod and cladribine for at least 3 months, who had not had an attack in the last month, who had an EDSS score of 3 or less, who did not use any antidepressive medication, and who signed the patient consent form. Hamilton Depression Rating Scale (HADS), Hamilton Anxiety Rating Scale (HADS) and Multiple sclerosis Quality of Life-54 (MSQOL-54) questionnaires were administered to 40 MS patients using Fingolimod and 40 MS patients using cladribine. The patients' age, gender, disease duration, occupation, EDSS scores and Magnetic Resonance Imaging (MRI) lesion location burden were examined (periventricular-cortical, cerebellar, brainstem and medulla spinalis) XII Results: In our study, it was found that MS patients have higher rates of depression and anxiety than the normal population. Additionally, the total scores from the MSQOL-54 questionnaire are below the normal population.. No significant statistical difference was detected in terms of depression and anxiety between the DMDs (fingolimod and Cladribine) used by the patients. When evaluated in terms of quality of life, the scores obtained from the energy/fatigue subgroup of the Composite Physical Health (CPH) main group of patients using fingolimod were found to be significantly higher than those using cladribine. The total score of patients using fingolimod in the Composite Mental Health (CMH) main group was found to be higher than patients using cladribine. No statistically significant difference was detected between the medications used by the patients and the scores of the Change in Health subgroup and Satisfaction with Sexual Function subgroup, which are independent items of MSQOL-54. A negative relationship was found between the patient's age, disease duration, EDSS scores, lesion site burden and quality of life. Additionally, a statistically significant difference was found in terms of the distribution of the patients' professions according to the drugs they used (X2=11.635; p<0.05). The proportion of unemployed and civil servant patients in the patient group using cladribine was higher than in patients using fingolimod; It was found that the rate of patients who were housewives, workers and students was lower than that of patients using fingolimod. Conclusion: In our study, no difference was found in depression and anxiety between fingolimod and cladribine used as DMD. In terms of quality of life, those using fingolimod have higher scores. This is attributed to the fact that cladribine has been used in the treatment of MS patients for the last few years and is mostly used in patients with lesion burden. Quality of life in MS is not only affected by drug use; Age, disease duration, EDSS score, lesion location and burden affect it. This issue needs more study. Keywords: Multıple Skelerosis (MS), Quality of life, depression and anxiety