Beta-2 agonistas de ultra longa duração para o tratamento da asma: há espaço?
Ultra long-term beta-2 agonists for treatment of asthma: is there a place?
Adelmir Souza-Machado; Carolina de Souza-Machado; Eduardo Costa; José Angelo Rizzo; Alfeu T. França; Flávio Sano; Gustavo F. Wandalsen; Marcelo V. Aun; Pedro F. Giavina-Bianchi Jr.; João Negreiros Tebyriçá; Dirceu Solé
Resumo
Objetivos: Revisar a eficácia e a tolerabilidade dos agentes beta-2 agonistas de longa ação (ultra-BALA) em asmáticos.
Métodos: Foi conduzida uma revisão sistemática de estudos clínicos que investigaram a eficácia e tolerabilidade de fármacos beta-2 agonistas administrados 1 vez ao dia, por via inalatória para o tratamento de pacientes com diagnóstico de asma brônquica. A pesquisa incluiu todos os manuscritos publicados na íntegra nos últimos 20 anos, na língua inglesa, utilizando as palavras-chaves “ultra-long-acting-beta agonits”, “carmoterol”, “indacaterol”, “vilanterol”, “arfomoterol”, “bronchodilators”, “combination therapy”, “once-daily” AND (“asthma treatment” [Mesh] OR “asthma/drug therapy” [Mesh] OR “bronchial asthma/therapy” [Mesh]) AND “randomized controlled trial”.
Resultados: Foram selecionados 8 ensaios clínicos que avaliaram 975 pacientes asmáticos. O indacaterol foi o agente farmacológico que apresentou estudos publicados em fases mais avançadas em asmáticos. Em estudos pré-clínicos e clínicos o indacaterol mostrou boa eficácia, segurança e tolerabilidade. O início de ação broncodilatadora é rápida e duradoura por 24 horas. Os efeitos adversos mais comuns foram tosse, cefaleia e nasofaringite; geralmente mínimos e de leve intensidade.
Conclusões: Os fármacos ultra-BALA podem constituir-se em opções promissoras para uso em dose única diária para um subgrupo de asmáticos que apresenta resposta terapêutica insuficiente e baixa aderência ao tratamento.
Palavras-chave
Abstract
Objectives: To review the efficacy and tolerability of the ultra- longacting beta 2 agonists agents (ultra-LABA) in asthmatics.
Methods: We conducted a systematic review of clinical studies that investigated the efficacy and tolerability of inhaled beta-2 agonist drugs administered once daily for the treatment of patients with bronchial asthma. The search included all full-length manuscripts published in the last 20 years, in English, by using the keywords “ultra-long-acting beta-agonits”, “carmoterol”, “indacaterol”, “vilanterol”, “arfomoterol” “bronchodilators”, “combination therapy”, “once-daily” AND (“asthma treatment” [Mesh] OR “asthma/drug therapy” [Mesh] OR “bronchial asthma/therapy” [Mesh]) AND “randomized controlled trial.”
Results: We selected 8 clinical trials that evaluated 975 patients with asthma. Indacaterol was the pharmacological agent that presented published studies at later stages in asthmatics. In preclinical and clinical studies indacaterol showed good efficacy, safety and tolerability. The bronchodilator effect is fast and lasts for 24 hours. The most common adverse events were cough, headache and nasopharyngitis, often minimal or mild.
Conclusions: The ultra-LABA can become promising options for a single daily dose regime for a subgroup of patients presenting insufficient therapeutic response and low adherence to treatment.
Keywords
Referências
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Submetido em:
28/09/2011
Aceito em:
30/11/2011
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