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¿Qué hemos aprendido de los grandes ensayos de tratamiento farmacológico en EPOC?
Peter M A Calverley1, Stephen I Rennard
1Division of Infection and Immunity, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK. pmacal@liverpool.ac.uk
Lancet (London, England)
|September 4, 2007
Resumen
Los ensayos clínicos muestran que los tratamientos para la enfermedad pulmonar obstructiva crónica (EPOC) mejoran el rendimiento del ejercicio al aumentar el volumen pulmonar. La investigación futura debe centrarse en estudios objetivos de alto nivel para avanzar en el manejo y la comprensión de la EPOC.
Área de la Ciencia:
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
- La investigación clínica es la investigación clínica.
Sus antecedentes:
- El desarrollo del tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado, a pesar de no ser una alta prioridad.
- Los estudios clínicos a gran escala son cruciales para evaluar la efectividad del tratamiento de la EPOC debido a la naturaleza crónica de la enfermedad y las exacerbaciones intermitentes.
Objetivo del estudio:
- Revisar el panorama actual de los estudios clínicos para el tratamiento de la EPOC.
- Para resaltar la importancia del diseño riguroso de ensayos y medidas de resultados en la investigación de la EPOC.
Principales métodos:
- Análisis de los datos de ensayos controlados aleatorios (ECA) que examinan los tratamientos para la EPOC.
- Evaluación de medidas de resultado establecidas y emergentes en ensayos clínicos de EPOC.
Principales resultados:
- Los tratamientos de EPOC mejoran el rendimiento del ejercicio principalmente al aumentar el volumen pulmonar, no el flujo expiratorio.
- El estado de salud, la frecuencia de exacerbaciones y los ingresos hospitalarios ahora se reconocen como resultados clave del tratamiento junto con la función pulmonar.
Conclusiones:
- Los ECA proporcionan la evidencia más sólida de la eficacia del tratamiento de la EPOC, pero están sujetos a variaciones en el diseño y la participación del paciente.
- Las pruebas de reversibilidad de los broncodilatadores no son un método confiable para identificar subgrupos de pacientes que responderán a tratamientos específicos.
- Los ensayos clínicos de alta calidad y de potencia adecuada son esenciales para avanzar en la comprensión y el manejo de la EPOC.
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