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Prueba de ciclosporina en el asma crónica severa dependiente de corticosteroides
A G Alexander1, N C Barnes, A B Kay
1Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, UK.
Lancet (London, England)
|February 8, 1992
Resumen
La ciclosporina mejoró significativamente la función pulmonar y redujo las exacerbaciones del asma en pacientes con asma grave crónica. Este fármaco inmunosupresor ofrece una nueva vía de tratamiento potencial al dirigirse a los linfocitos T involucrados en la patogénesis del asma.
Área de la Ciencia:
- Inmunología Inmunología.
- Pulmonología Pulmonología.
- Farmacología Farmacología.
Sus antecedentes:
- El tratamiento del asma grave crónica sigue siendo un desafío para muchos pacientes.
- La dependencia de corticosteroides es común en el asma grave, lo que indica procesos inflamatorios subyacentes.
- Los linfocitos T están implicados en la patogénesis del asma, lo que los sugiere como un objetivo terapéutico.
Objetivo del estudio:
- Evaluar la eficacia de la ciclosporina en la mejora de la función pulmonar en pacientes asmáticos dependientes de corticosteroides.
- Evaluar el impacto de la ciclosporina en las exacerbaciones del asma y el control de la enfermedad.
- Investigar la seguridad y tolerabilidad de la ciclosporina en esta población de pacientes.
Principales métodos:
- Se realizó un ensayo cruzado aleatorizado, doble ciego, controlado con placebo.
- Participaron 33 pacientes con asma de larga data, severa y dependiente de corticosteroides.
- Los pacientes recibieron ciclosporina (5 mg / kg / día) o placebo durante 12 semanas, seguido de un cruce después de un lavado de 2 semanas.
Principales resultados:
- La ciclosporina aumentó significativamente la velocidad de flujo expiratorio pico matutino (PEFR) en un 12,0% y el volumen expiratorio forzado en 1 segundo (FEV1) en un 17,6% en comparación con el placebo.
- La frecuencia de las exacerbaciones de asma que requieren un aumento de la dosis de prednisolona se redujo en un 48% con ciclosporina.
- La variación diurna en la PEFR disminuyó en un 27,6% con el tratamiento con ciclosporina, y el medicamento fue generalmente bien tolerado.
Conclusiones:
- La ciclosporina demuestra beneficios significativos en la mejora de la función pulmonar y la reducción de las exacerbaciones en el asma severa, dependiente de corticosteroides.
- Estos hallazgos apoyan el papel de los linfocitos T activados en la patogénesis del asma.
- Dirigirse a los linfocitos T con agentes como la ciclosporina representa una prometedora nueva estrategia terapéutica para el manejo del asma.
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