Nintedanib y pirfenidona en el tratamiento farmacológico de la fibrosis pulmonar idiopática: perspectivas actuales y futuras. / Nintedanib and pirfenidone for the treatment of idiopathic pulmonary fibrosis: current and future perspectives.
Resumen
Resumen.
La fibrosis pulmonar idiopática es una enfermedad progresiva y fatal. En los últimos años se han identificado algunos factores involucrados en el desarrollo de la lesión del epitelio alveolar y en el remodelado anormal que conducen a la fibrosis, los cuales han sido evaluados para el desarrollo de tratamientos específicos. Dos terapias modificadoras de la enfermedad, pirfenidona y nintedanib, han demostrado reducir la progresión de la enfermedad, en términos de disminución de la capacidad vital forzada, con un efecto limítrofe sobre la mortalidad. Estos medicamentos han sido aprobados para su uso en pacientes con deterioro leve a moderado de la función pulmonar. Estudios de la vida real han evaluado estos tratamientos en poblaciones no representadas en los ensayos clínicos, con beneficios, seguridad y tolerancia similares. Los medicamentos difieren en su perfil de seguridad, pero ninguno ha demostrado ser mejor al otro en términos de eficacia. La decisión de comenzar estos tratamientos debe ponderar la gravedad de la enfermedad y las expectativas y preferencias del paciente. El tratamiento farmacológico combinado posiblemente será el tratamiento estándar en el futuro, pero nuevos estudios deberán evaluar su eficacia.
Abstract.
Idiopathic pulmonary fibrosis is a progressive and fatal disease. In recent years, some factors involved in the pathophysiology of the alveolar epithelial injury and in the abnormal remodeling that lead to fibrosis have been identified, some factors involved in the pathophysiology of the alveolar epithelial injury and in the abnormal remodeling that lead to fibrosis have been identified, some of them have been evaluated for the development of specific treatments. Two disease-modifying therapies, pirfenidone and nintedanib, have demonstrated to reduce the progression of the disease, in terms of decline in forced vital capacity, with a borderline effect on mortality. These drugs have been approved for patients with mild to moderate impairment in pulmonary function tests. Real-life studies have evaluated these treatments in populations not represented in clinical trials, with similar benefits, safety and tolerance. Pirfenidone and nintedanib have different safety profiles, but none is better in terms efficacy. Decision to start treatment should weight the severity of the disease and the patient’s expectations and preferences. Combined drug treatment possibly will be the standard of treatment in the future, but further studies must assess its efficacy.
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