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Manejo farmacológico para reducir las exacerbaciones en adultos con asma: una revisión sistemática y metaanálisis
Don D Sin1, Jonathan Man, Heather Sharpe
1James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, University of British Columbia, Vancouver, Canada. dsin@mrl.ubc.ca
JAMA
|July 22, 2004
Resumen
Los corticosteroides inhalados son el tratamiento más efectivo para el asma, ya que reducen significativamente las exacerbaciones. Otras terapias como los modificadores de leucotrienos y los anti-IgE ofrecen alternativas para grupos específicos de pacientes.
Área de la Ciencia:
- Pulmonología Pulmonología.
- Farmacología Farmacología.
- La medicina clínica es la medicina clínica.
Sus antecedentes:
- La morbilidad por asma ha aumentado, lo que ha provocado el desarrollo de nuevos agentes farmacológicos.
- El impacto a largo plazo de estos medicamentos para el asma en la frecuencia de exacerbaciones sigue sin estar claro.
Objetivo del estudio:
- Revisar y sintetizar sistemáticamente los datos a largo plazo sobre los corticosteroides inhalados (ICS), los agonistas beta2 de acción prolongada (LABA), los modificadores de la vía de los leucotrienos/antagonistas de los receptores (LTM/TRA) y las terapias anti-IgE.
- Evaluar los efectos de estos medicamentos para el asma en los resultados clínicos y las exacerbaciones en pacientes adultos con asma crónica.
Principales métodos:
- Una búsqueda exhaustiva de la literatura de las bases de datos MEDLINE, EMBASE y Cochrane (1980-2004).
- Inclusión de ensayos controlados aleatorios doble ciego con seguimiento ≥3 meses y datos sobre exacerbaciones o FEV1.
- Análisis comparativo con placebo, agonistas beta2 de acción corta u otros tratamientos activos.
Principales resultados:
- Los corticosteroides inhalados (ICS) demostraron la mayor eficacia, reduciendo las exacerbaciones en un 55% (RR, 0.46; IC del 95%, 0.34-0.62).
- Los agonistas beta2 de acción prolongada (LABA) redujeron las exacerbaciones en un 25% (RR, 0,75; IC del 95%, 0,64-0,88) y mostraron un beneficio adicional cuando se combinaron con ICS (RR, 0,74; IC del 95%, 0,61-0,91).
- Los modificadores de leucotrienos / antagonistas de los receptores (LTM / TRA) redujeron las exacerbaciones en un 41% (RR, 0,59; IC del 95%, 0,49-0,71), pero fueron menos efectivos que los ICS.
- La terapia anti-IgE, combinada con ICS, redujo las exacerbaciones en un 45% (RR, 0.55; IC del 95%, 0.45-0.66).
Conclusiones:
- Los corticosteroides inhalados (ICS) son la monoterapia más efectiva para el control de la exacerbación del asma en adultos.
- Los modificadores de leucotrienos/antagonistas de los receptores (LTM/TRA) son una alternativa viable para los pacientes que no pueden o no quieren usar ICS.
- LABA se puede agregar a ICS para pacientes sintomáticos, y la terapia anti-IgE es un tratamiento complementario potencial para el asma alérgica con IgE elevado.
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