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Definición de la respuesta parcial en la enfermedad inflamatoria intestinal: un consenso de Delphi y una evaluación
Iago Rodríguez-Lago1,2,3, Luis Menchén4,5, José Germán Sánchez-Hernández6
1Hospital de Galdakao-Usansolo, Galdakao, Spain.
Therapeutic advances in gastroenterology
|August 21, 2025
Resumen
La definición de las respuestas parciales en la enfermedad inflamatoria intestinal (EII) es crucial para la atención del paciente. Este estudio estableció definiciones de consenso para la respuesta parcial en la colitis ulcerosa y la enfermedad de Crohn, ayudando a la toma de decisiones clínicas.
Área de la Ciencia:
- Gastroenterología y Hepatología
- Medicina Clínica
- Investigación de las enfermedades inflamatorias intestinales
Sus antecedentes:
- Los objetivos terapéuticos en la enfermedad inflamatoria intestinal (EII) están evolucionando con nuevos tratamientos y diagnósticos.
- A pesar de los avances, persisten importantes necesidades clínicas no cubiertas en el manejo de la EII.
- Una definición clara de la respuesta al tratamiento es esencial para optimizar la atención al paciente.
Objetivo del estudio:
- Establecer una definición de consenso para los "respondientes parciales" en la práctica clínica de la EII.
- Diferenciar a los pacientes que no cumplen con los objetivos terapéuticos definidos en el plazo previsto.
- Proporcionar criterios claros para evaluar la eficacia del tratamiento en varios escenarios de EII.
Principales métodos:
- Una consulta de dos rondas en Delphi en la que participaron 60 gastroenterólogos especializados en EII en España.
- Un cuestionario de 22 puntos que aborda cuatro escenarios clínicos: colitis ulcerosa moderada (UC), UC aguda grave, enfermedad de Crohn luminal (CD) y CD perianal.
- Consenso definido como el acuerdo de 70% de los panelistas utilizando una escala de Likert de 7 puntos; análisis de los costos anuales asociados para los que respondieron parcialmente frente a la remisión.
Principales resultados:
- Se llegó a un consenso sobre las definiciones de respuesta parcial en UC y CD, incorporando puntuaciones clínicas, biomarcadores y hallazgos por imágenes/endoscopia.
- Los costos anuales estimados para los pacientes con respuesta parcial fueron significativamente más altos que para los pacientes en remisión: 2570,40 € (UC) frente a 820,20 €, 1607,30 € (CD luminal) frente a 718,0 € y 2886,70 € (CD perianal) frente a 888,80 €.
- El logro de una remisión prolongada podría generar ahorros sustanciales (55%-70%) en el uso de recursos no farmacológicos y los costos asociados.
Conclusiones:
- Se han establecido definiciones formales para los pacientes con respuesta parcial en cuatro escenarios clínicos clave de EII.
- Estas definiciones pueden ayudar a los profesionales de la salud en la toma de decisiones clínicas y en la gestión del paciente.
- La mejora de la atención al paciente y el ahorro potencial de costos se pueden lograr mediante una mejor identificación y gestión de la respuesta al tratamiento en la EII.
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