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Terapia combinada de litio más valproato versus monoterapia para la prevención de recaídas en el trastorno bipolar I
1, John R Geddes, Guy M Goodwin
1Oxford Clinical Trials Unit for Mental Illness, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. john.geddes@psych.ox.ac.uk
Lancet (London, England)
|January 23, 2010
Resumen
La terapia de combinación con litio y valproato, y litio solo, son más eficaces que el valproato solo para prevenir la recaída del trastorno bipolar I. Este hallazgo ofrece mejores opciones de tratamiento para los pacientes que experimentan episodios de estado de ánimo.
Área de la Ciencia:
- La psiquiatría es la psiquiatría.
- Farmacología Farmacología.
- Los ensayos clínicos son ensayos clínicos.
Sus antecedentes:
- La recaída del trastorno bipolar I es una causa significativa de discapacidad.
- El carbonato de litio y el valproato semisódico son monoterapias recomendadas, pero a menudo carecen de toda la eficacia.
- La terapia de combinación puede ofrecer una mejor prevención de recaídas.
Objetivo del estudio:
- Para comparar la eficacia de la terapia de combinación de litio más valproato frente a la monoterapia con cualquiera de los agentes para prevenir la recaída en el trastorno bipolar I.
- Para evaluar si la terapia de combinación proporciona una prevención de recaídas superior en comparación con la monoterapia con litio o valproato.
Principales métodos:
- Un ensayo aleatorizado abierto en el que participaron 330 pacientes con trastorno bipolar tipo I.
- Los participantes recibieron monoterapia con litio, monoterapia con valproato o una combinación de ambos.
- Seguimiento por hasta 24 meses, siendo el resultado primario el inicio de una nueva intervención para los episodios de estado de ánimo emergentes.
Principales resultados:
- La terapia de combinación (54%) y la monoterapia con litio (59%) mostraron una tasa más baja de eventos de resultado primario en comparación con la monoterapia con valproato (69%).
- La terapia de combinación fue significativamente mejor que la monoterapia con valproato (HR 0.59, p = 0.0023).
- La monoterapia con litio también fue significativamente mejor que la monoterapia con valproato (HR 0.71, p=0.0472).
Conclusiones:
- La terapia combinada de litio más valproato y la monoterapia con litio son más efectivas que la monoterapia con valproato para prevenir la recaída en el trastorno bipolar I.
- Los beneficios de estos tratamientos se mantienen hasta dos años y son independientes de la gravedad de la enfermedad al inicio.
- El estudio no pudo confirmar o refutar definitivamente un beneficio de la terapia de combinación sobre la monoterapia con litio.
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