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Eficacia y seguridad de los antihistamínicos orales para la rinitis alérgica: metaanálisis en red
Rafael José Vieira1, Sara Gil-Mata1, André Ferreira2
1MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.
The journal of allergy and clinical immunology. In practice
|February 18, 2026
Resumen
Los antihistamínicos H1 orales (OAH) ofrecen alivio para la rinitis alérgica (RA). Si bien algunos OAH muestran una eficacia ligeramente mejor, la mayoría de las opciones de segunda generación tienen perfiles de seguridad similares y diferencias menores en efectividad.
Área de la Ciencia:
- Farmacología
- Medicina Clínica
- Medicina Basada en Evidencia
Sus antecedentes:
- Los antihistamínicos H1 orales (OAH) se prescriben frecuentemente para la rinitis alérgica (RA).
- Evaluar la eficacia y seguridad comparativa de diferentes OAH es crucial para la toma de decisiones clínicas.
Objetivo del estudio:
- Realizar una revisión sistemática y un metaanálisis en red.
- Comparar la eficacia y seguridad de los OAH individuales en pacientes con RA.
Principales métodos:
- Se buscaron bases de datos múltiples de ensayos controlados aleatorizados (ECR) que compararan OAH frente a placebo u OAH individuales.
- Se realizó un metaanálisis en red sobre puntuaciones de síntomas, calidad de vida y eventos adversos.
- Se evaluó la certeza de la evidencia utilizando GRADE-NMA para OAH de segunda generación.
Principales resultados:
- Se incluyeron 74 ECR (21 RA perenne, 53 RA estacional).
- La cetirizina, ebastina, bilastina y rupatadina mostraron alta eficacia para síntomas nasales; otros resultados variaron.
- Las tasas de eventos adversos fueron similares entre los OAH de segunda generación; los eventos graves fueron raros.
- La certeza de la evidencia fue generalmente baja o muy baja.
Conclusiones:
- Algunos OAH pueden ser más eficaces, pero las diferencias entre los medicamentos de segunda generación suelen ser triviales.
- No se encontraron diferencias significativas en los perfiles de seguridad entre los OAH de segunda generación.
- Existe una incertidumbre sustancial con respecto a los efectos del tratamiento debido a la baja certeza de la evidencia.
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