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Resumen general del tratamiento con azatioprina en la esclerosis múltiple
P L Yudkin1, G W Ellison, A Ghezzi
1Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford, UK.
Lancet (London, England)
|October 26, 1991
Resumen
La azatioprina mostró un pequeño beneficio en la reducción de la progresión de la discapacidad en pacientes con esclerosis múltiple después de dos años de tratamiento. Sin embargo, redujo significativamente las tasas de recaída, aunque el beneficio clínico general frente a los efectos secundarios sigue siendo discutible.
Área de la Ciencia:
- Neurología Neurología.
- Inmunología Inmunología.
Sus antecedentes:
- La esclerosis múltiple (EM) es una enfermedad autoinmune crónica que afecta al sistema nervioso central.
- Las terapias inmunosupresoras se utilizan para controlar la EM, pero su eficacia y los perfiles de riesgo-beneficio requieren una evaluación continua.
Objetivo del estudio:
- Evaluar la eficacia de la azatioprina en el tratamiento de la esclerosis múltiple (EM).
- Evaluar el impacto de la azatioprina en la progresión de la discapacidad y las tasas de recaída en pacientes con EM.
Principales métodos:
- Metaanálisis de ensayos ciegos, aleatorizados y controlados publicados.
- Inclusión de 793 pacientes en 7 estudios (5 doble ciego, 2 ciego único).
- Evaluación de las puntuaciones del estado de discapacidad de Kurtzke y la probabilidad de no recaída durante 3 años.
Principales resultados:
- No hay diferencia significativa en el aumento de la puntuación de discapacidad después de 1 año.
- Un beneficio pequeño y sostenido en la puntuación de discapacidad que favorece a la azatioprina a los 2 y 3 años.
- Probabilidad significativamente mayor de no recaída en el grupo de azatioprina durante 3 años (probabilidad relativa 1,97).
Conclusiones:
- La azatioprina demuestra un beneficio modesto en la ralentización de la progresión de la discapacidad en la EM.
- La azatioprina reduce significativamente la frecuencia de recaídas en pacientes con esclerosis múltiple.
- Las ventajas clínicas de la azatioprina deben sopesarse frente a los posibles efectos secundarios.
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