Palabras clave
Revisión sistemática
Corticoides nasales
Tratamiento
Calidad de vida Allergic rhinitis
Steroids
Adults
Fever
Systematic review
Quality of life
Cómo citar
Resumen
Objetivo: determinar la eficacia de los corticoides tópicos nasales comparados con placebo en el control global de los síntomas nasales en pacientes adultos con rinitis alérgica. Diseño: revisión sistemática y meta-análisis de la literatura. Población: experimentos controlados aleatorizados que comparaban esteroides intranasales contra placebo en adultos con rinitis alérgica. Intervenciones: corticoides tópicos nasales comparados con placebo. Medición: el desenlace principal fue la proporción de sujetos que lograba mejoría global en cuatro síntomas nasales. Los desenlaces secundarios fueron la mejoría en cada uno de los síntomas nasales, en la calidad de vida y la frecuencia de efectos adversos. Resultados: la búsqueda en bases de datos de literatura, manualmente en revistas no indexadas, en los resúmenes de conferencias científicas y a través de contacto con autores y casas farmacéuticas permitió identificar 1251 estudios. Dos revisores independientes seleccionaron, evaluaron la calidad y extrajeron los datos de 27 de ellos. Aunque hubo heterogeneidad en la intervención y en los métodos de medición de los desenlaces, todos los estudios encontraron mejoría global de los síntomas con el esteroide tópico nasal. Un meta-análisis con el modelo de efectos aleatorios produjo un riesgo relativo de 0.46 (IC95% 0.40 - 0.54). Estos resultados fueron similares a los obtenidos con el modelo de efectos fijos. El análisis de la gráfica de embudo no permite descartar sesgo de publicación. Ante la presencia de heterogeneidad no se realizó un meta-análisis para cada uno de los síntomas. Sin embargo, los resultados puntuales de los estudios fueron homogéneos a favor de los esteroides tópicos nasales. Sólo tres estudios evaluaron la calidad de vida, y un meta-análisis con los modelos de efectos fijos y aleatorios no encontró diferencias significativas (diferencia ponderada de medias de -0.97; IC95% -2.35 a 0.40). Los efectos adversos reportados más frecuentemente fueron secreción sanguinolenta, sensación de ardor nasal y resequedad nasal. Conclusiones: los resultados indican que el uso de esteroides tópicos nasales reduce a la mitad el riesgo de no mejoría de los síntomas, y mejoran favorablemente cada uno de los síntomas individuales. No se encontraron diferencias en la calidad de vida, aunque el número de estudios que ha evaluado este desenlace es pequeño. Estos resultados deben interpretarse con cautela debido a la heterogeneidad clínica y metodológica de los estudios y por la probabilidad de sesgo de publicación.
Citas
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