La información que se presenta es muy adecuada y da un panorama acerca de los principales medicamentos para manejar la HAP.
Sólo quisiera hacer algunas aclaraciones.
1. Calcioantagonistas: NO están aprobados en México ni en ninguna otra parte del mundo para manejo de HAP. esto no significa que como se menciona no sean útiles. Son útiles en aquellos pacientes correctamente seleccionados (reto farmacológico). Y su uso se conoce como "off label".Los criterios de respuesta al reto farmacológico (que puede ser con adenosina, óxido npítrico o incluso flolan) son que la presión media pulmonar disminuya a un valor absoluto de 45 mmHg o menos (y que esto sea al menos de 20% en relación a la cifra basal).
2.Sildenafil. Los estudios Super-1 y Super-2 fueron los estudios pivote para que la FDA y la EMEA (agencia europea)aprobaran el Revatio, es importante señalar que México participó en este estudio. Actualmente se está llevando a acabo un estudio multicéntrico en niños con hipertensión pulmonar para ver si el Sildenafil les es útil. México, al igual que varios países de latinoamérica están también participando.
Espero que demostrando que se tiene esta experiencia en nuestro país eventualmente se pueda aprobar el Revatio.
3. Bloqueadores de Endotelina. La endotelina es una substancia que al unirse a sus receptores en la célula de músculo liso producen constricción (lo cual cierra las arterias), lo bloqueadores impiden esta función, no es que la endotelina tenga que entrar a la célula, de hecho todos tenemos endotelina en la circulación.Sólo existe un tipo de Endotelina, lo que es diferente (A y B) son los receptores a los que ésta se une. Como se menciona, el Receptor B tiene doble función por un lado tiene un efecto deletéreo en la célula de músculo liso, pero en la célula endotelial produce OXIDO NITRICO que vasodilata. No es una teoría este mecanismo de acción ya se ha comprobado y por eso la disyuntiva entre bloquear los dos receptores (Ay B) o sólo el A.
Con Bosentan ya existen estudios a largo plazo donde se ha demostrado que los pacientes que lo toman tienen una mejor sobrevida.
4. Prostaciclinas.El Ventavis (Iloprost) que se utiliza de forma inhalada probablemente sea el primer medicamento aprobado en México para HAP y se espera que se apruebe en Noviembre o Diciembre.Nuevamente, a partir de Octubre participaremos en el protocolo de Treprostinil oral por lo que si alguien está interesado puede contactarnos.
Espero que esta información les sea de utilidad
Informacion por parte del Dr. Tomas Pulido.
Instituto de Cardiologia.
Suscribirse a:
Comentarios de la entrada (Atom)
78 comentarios:
quien es el dr.pulido?
Interesante informacion ya que estoy haciendo un trabajo sobre Bloqueadores de Endotelina y todos sus efectos y me parece muy bueno que usted posteara sobre esto gracias
este es un problema de mucha incidencia y al parcer de poco tratar en muchos aspectos la toma de diciciones en este tipo de trataminetos parece ser una de las cosas que no siempre gusta a quienes padecen de la emfermadad por lo que optan por no llevarlo a cabo..mi hermano por ejemplo prefirio seguir tomando Generic Levitra a seguir con con el tratamiento para la hipertencion lo cual hasta el momento no le a traido buenas concecuencias por lo que hinsto a llevar a cabo los tratamientos!!
Interesante informacion muy util pero me gustaria mucho saber mas sobre el trabajo de FDA y la EMEA ya que son conocidas pero no e leido mucho sobre ellas
no conosco mucho del tema pero reciente mente realice un estudio acerca del herpes infection en donde me di cuenta que. Con Bosentan ya existen estudios a largo plazo donde se ha demostrado que los pacientes que lo toman tienen una mejor sobrevida.y La endotelina es una substancia que al unirse a sus receptores en la célula de músculo liso producen constricción (lo cual cierra las arterias)
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El Dr. Tomás Pulido es especialista en Neumología, con estudios de especialización en Cardioneumología en el Instituto Nacional de Cardiología,jefe del Departamento de Cardioneumología, miembro de la Sociedad Mexicana de Cardiología y de la American Thoracic Society, maestro titular de la materia de Nosología en la Facultad Mexicana de Medicina de la Universidad La Salle.
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