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Revisión sistemática con metaanálisis: seguridad y eficacia de la combinación de productos biológicos y moléculas

Scott R Anderson¹, Ali Osman¹, Mohammad Zamani²

¹Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States.

Inflammatory bowel diseases

|August 22, 2025

Resumen

La combinación de productos biológicos y moléculas pequeñas es prometedora para los pacientes con enfermedades inflamatorias refractarias intestinales (IBD). La consideración cuidadosa de los perfiles de seguridad es crucial antes de implementar estas terapias avanzadas.

Área de la Ciencia:

Gastroenterología
Inmunología
Farmacología

Sus antecedentes:

Revisión sistemática y metanálisis (SRMA) de las terapias combinadas para las enfermedades inflamatorias refractarias intestinales (IBD).
Centrarse en la seguridad y eficacia de los productos biológicos y/o de las pequeñas moléculas.
Búsqueda actualizada de mayo de 2020 a enero de 2024.

Objetivo del estudio:

Evaluar la seguridad y eficacia de las terapias combinadas biológicas y/o de moléculas pequeñas en la EII.
Identificar las estrategias de combinación óptimas para la EII refractaria al tratamiento.
Evaluar los eventos adversos y las tasas de respuesta/remisión.

Principales métodos:

Revisión sistemática y metanálisis actualizados.
Se incluyeron 27 estudios con 619 pacientes y 631 ensayos terapéuticos.
Modelo de varianza inversa de efectos aleatorios para las estimaciones agrupadas.

Principales resultados:

Upadacitinib (UPA) + vedolizumab (VDZ) y tofacitinib (Tofa) + anti- TNF (aTNF) mostraron bajas tasas de eventos adversos (EA).
Natalizumab (NAT) + aTNF y aTNF + guselkumab tuvieron tasas más altas de AE.
UPA + UST y UPA + VDZ demostraron altas tasas de respuesta clínica y de remisión.

Conclusiones:

Las terapias combinadas pueden ser efectivas en pacientes con EII que no responden a la monoterapia.
Los perfiles de seguridad de los tratamientos combinados requieren una evaluación cuidadosa.
Se necesita más investigación para optimizar la implementación clínica de estas estrategias.

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