Seguridad y utilidad del sildenafil, bosetán y terapia combinada en hipertensión arterial pulmonar según la respuesta de capacidad funcional
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2023
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Durante las últimas décadas se han probado alternativas terapéuticas para el
tratamiento de la HAP, permitiendo su abordaje con análogos de prostaciclina, estimuladores
de guanilato ciclasa soluble (o inhibidores de fosfodiesterasa tipo 5) y antagonistas de
receptores de endotelina. El objetivo de este trabajo final de investigación fue establecer el
nivel de seguridad y utilidad del sildenafil, bosentán y terapia combinada en su tratamiento
según la respuesta de capacidad funcional. Los resultados obtenidos para la población de 70
pacientes tratados con monoterapia (bosentán y sildenafil) y terapia combinada fueron una
caracterización poblacional con mayoría de mujeres entre los 27 y 49 años, sin presencia de
FR en el 60%. La HAP fue 71% congénita, 14% idiopática, 9% asociadas a ETC y un 6%
asociada a VIH. El 41,4% fue tratado con sildenafil, 54,3% con terapia combinada y 4,3%
con bosentán. Pretratamiento, las clases funcionales con más individuos (NYAH) fueron II
y III. Postratamiento, se presentó una mejora, con más pacientes en clases I y II. Comparadas,
la monoterapia con sildenafil tuvo mayor eficacia, seguida por terapia combinada. El
tratamiento con bosentán presentó mejorías, pero igualmente un retroceso de clase II a III. El
tratamiento más seguro fue bosentán (sin efectos secundarios) seguido por sildenafil y terapia
combinada, con el 6,9% y 26,3% de prevalencia de efectos secundarios, respectivamente. Se
concluyó que tanto en el pre y pos tratamiento Sildenafil mostró mayor seguridad y eficacia,
pero con resultados más significativos el pre tratamiento de capacidad funcional; se sugiere
prestar atención a otros estudios para dar contundencia a esta evidencia y evitar el uso de
fármacos con poca población
During the last decades, therapeutic alternatives for the treatment of PAH have been tested, allowing its approach with prostacyclin analogues, soluble guanylate cyclase stimulators (or phosphodiesterase type 5 inhibitors) and endothelin receptor antagonists. The aim of this study was to determine the level of safety and usefulness of sildenafil, bosentan and combination therapy in their treatment. The results obtained for the population of 70 patients treated with monotherapy (bosentan and sildenafil) and combined therapy were a population characterization with a majority of women between 27 and 49 years of age, without the presence of risk factors in 60%. The type of PAH was 71% congenital, 14% idiopathic, 9% associated with CTE and 6% associated with HIV. The 41.4% were treated with sildenafil, 54.3% with combined therapy and 4.3% with bosentan. Pretreatment, the functional classes with more individuals (NYAH) were II and III. Post-treatment, there was an improvement, with more patients in classes I and II. Compared, sildenafil monotherapy had greater efficacy, followed by combined therapy. Treatment with bosentan showed improvement, but also a regression from class II to III. The safest treatment was bosentan (no side effects) followed by sildenafil and combination therapy, with 6.9% and 26.3% prevalence of side effects, respectively. It was concluded that both pre- and post-treatment Sildenafil showed greater safety and efficacy, but with more significant results in the pretreatment of functional capacity; it is suggested to pay attention to other studies to give strength to this evidence and avoid the use of drugs with small population.
During the last decades, therapeutic alternatives for the treatment of PAH have been tested, allowing its approach with prostacyclin analogues, soluble guanylate cyclase stimulators (or phosphodiesterase type 5 inhibitors) and endothelin receptor antagonists. The aim of this study was to determine the level of safety and usefulness of sildenafil, bosentan and combination therapy in their treatment. The results obtained for the population of 70 patients treated with monotherapy (bosentan and sildenafil) and combined therapy were a population characterization with a majority of women between 27 and 49 years of age, without the presence of risk factors in 60%. The type of PAH was 71% congenital, 14% idiopathic, 9% associated with CTE and 6% associated with HIV. The 41.4% were treated with sildenafil, 54.3% with combined therapy and 4.3% with bosentan. Pretreatment, the functional classes with more individuals (NYAH) were II and III. Post-treatment, there was an improvement, with more patients in classes I and II. Compared, sildenafil monotherapy had greater efficacy, followed by combined therapy. Treatment with bosentan showed improvement, but also a regression from class II to III. The safest treatment was bosentan (no side effects) followed by sildenafil and combination therapy, with 6.9% and 26.3% prevalence of side effects, respectively. It was concluded that both pre- and post-treatment Sildenafil showed greater safety and efficacy, but with more significant results in the pretreatment of functional capacity; it is suggested to pay attention to other studies to give strength to this evidence and avoid the use of drugs with small population.
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HIPERTENSIÓN ARTERIAL PULMONAR, SILDENAFIL, BOSETAN, TERAPEUTICA, UTILIZACION DE MEDICAMENTOS, HOSPITAL DE ESPECIALIDADES GUAYAQUIL DR. ABEL GILBERT PONTON, CANTON GUAYAQUIL, ECUADOR