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Terapias de alivio inhaladas para el asma: una revisión sistemática y un metanálisis
Daniel G Rayner1, Dario M Ferri2, Gordon H Guyatt1
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
JAMA
|October 28, 2024
Resumen
El corticosteroide inhalado (ICS) combinado con formoterol o beta-agonistas de acción corta (SABA) reduce significativamente las exacerbaciones del asma y mejora el control de los síntomas en comparación con SABA solo. Estas terapias que contienen ICS ofrecen un mejor manejo del asma para los pacientes.
Área de la Ciencia:
- Pulmonología
- Farmacología clínica
- La medicina basada en la evidencia
Sus antecedentes:
- No se ha establecido definitivamente la estrategia óptima de alivio inhalado para el tratamiento del asma.
- Las directrices actuales sugieren diversos enfoques, lo que genera incertidumbre en la práctica clínica.
- Comparar diferentes terapias de alivio es crucial para optimizar los resultados de los pacientes.
Objetivo del estudio:
- Comparar la eficacia y la seguridad de los beta-agonistas de acción corta (SABA) en monoterapia frente al SABA combinado con corticosteroides inhalados (ICS).
- Evaluar el uso de beta-agonistas de acción rápida y prolongada (formoterol) en combinación con ICS como tratamiento de relevo.
- Determinar la mejor estrategia de alivio inhalado para el control del asma y la prevención de la exacerbación.
Principales métodos:
- Se realizó una búsqueda sistemática en las bases de datos MEDLINE, Embase y CENTRAL desde enero de 2020 hasta septiembre de 2024.
- Se incluyeron ensayos clínicos aleatorizados en los que se comparó el SABA solo, el ICS con formoterol y el ICS con SABA.
- Se utilizaron metaanálisis de efectos aleatorios y evaluaciones GRADE para sintetizar los datos sobre el control del asma, la calidad de vida y el riesgo de exacerbación.
Principales resultados:
- Ambas estrategias de alivio que contienen ICS (ICS-formoterol e ICS-SABA) redujeron significativamente las exacerbaciones graves del asma en comparación con SABA solo (alta certeza).
- El ICS-formoterol mostró una mayor reducción de las exacerbaciones que el ICS-SABA en comparaciones indirectas (seguridad moderada).
- Ambas terapias que contienen ICS mejoraron el control de los síntomas del asma en comparación con SABA solo (alta certeza) sin aumentar los eventos adversos graves.
Conclusiones:
- Los corticosteroides inhalados (ICS) combinados con formoterol o SABA son superiores a los SABA solos para reducir las exacerbaciones del asma.
- Estas terapias de alivio que contienen ICS mejoran significativamente el control de los síntomas del asma.
- El ICS-formoterol puede ofrecer una estrategia más eficaz para la reducción de la exacerbación en comparación con el ICS-SABA.
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