ESTRATEGIAS FARMACOLÓGICAS PARA EL MANEJO DE ENFERMEDADES CRÓNICAS: EVIDENCIA ACTUAL Y DESAFÍOS
DOI:
https://doi.org/10.56519/1b418y72Palabras clave:
Enfermedad crónica, farmacoterapia, medicina de precisión, adherencia al tratamiento, revisión sistemática, Chronic disease, pharmacotherapy, precision medicine, treatment adherence, systematic reviewResumen
El incremento de las enfermedades crónicas no transmisibles (ECNT) a nivel global plantea la mayor alarma sanitaria para la sostenibilidad de los actuales sistemas de salud. Este estudio tuvo como tarea la evaluación de las actuales estrategias farmacoterapéuticas para su tratamiento, a través de un análisis de la evidencia científica de mayor impacto y de las barreras protocolarias que las condicionan en la práctica clínica real. Se llevó a cabo una metodología de revisión bibliográfica sistemática de acuerdo a la declaración PRISMA y se seleccionaron 26 artículos científicos con criterio de selección estricto indexados en PubMed, Scopus y Web of Science del periodo 2021-2026. Las principales conclusiones destacan la evolución cualitativa hacia la medicina de precisión, así como hacia los últimos desarrollos en las múltiples terapias biológicas como es el uso de inhibidores de PCSK9, agonistas selectivos de GLP-1/GIP, inhibidores de SGLT2, cuyos beneficios son evidentes especialmente en lo concerniente a la morbimortalidad cardiorrenal. Se fundamentan brechas operativas como ser la baja adherencia terapéutica a largo plazo (inferior a un 50% en regímenes complejos), la toxicidad acumulada debida a la polifarmacia equivocada en la población anciana, y las marcadas desigualdades socioeconómicas en el acceso a estas innovaciones moleculares. En resumidas cuentas, una vez más, sí, es evidente que la innovación biofarmacéutica ha cambiado el pronóstico teórico de las enfermedades crónicas, pero el "éxito" clínico definitivo no depende únicamente de la eficacia de las moléculas, sino, por un lado, que transitemos a un modelo asistencial centrado en el paciente con un enfoque por la simplificación posológica y el soporte digital y por otro, la equidad en la distribución farmacéutica.
ABSTRACT:
The global rise in chronic noncommunicable diseases (CNCDs) poses the greatest health threat to the sustainability of current healthcare systems. The objective of this study was to evaluate current pharmacotherapeutic strategies for their treatment by analyzing the most impactful scientific evidence and the protocol-related barriers that limit their application in real-world clinical practice. A systematic literature review methodology was conducted in accordance with the PRISMA statement, and 26 scientific articles were selected using strict inclusion criteria from PubMed, Scopus, and Web of Science for the period 2021–2026. The main conclusions highlight the qualitative evolution toward precision medicine as well as the latest developments in various biological therapies, such as the use of PCSK9 inhibitors, selective GLP-1/GIP agonists, and SGLT2 inhibitors, whose benefits are evident, particularly regarding cardiorenal morbidity and mortality. Operational gaps include low long-term treatment adherence (less than 50% for complex regimens), cumulative toxicity resulting from inappropriate polypharmacy in the elderly population, and marked socioeconomic inequalities in access to these molecular innovations. In short, once again, yes, it is clear that biopharmaceutical innovation has changed the theoretical prognosis of chronic diseases, but definitive clinical “success” does not depend solely on the efficacy of the molecules, but rather, on the one hand, on our transition to a patient-centered care model with a focus on dosing simplification and digital support, and on the other hand, on equity in pharmaceutical distribution.
Referencias
Murray C, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors. Cambridge: Harvard University Press. 2021;
World Health Organization. Noncommunicable diseases progress monitor 2024. Geneva: World Health Organization. 2024;
Bloom D, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom L, Fathima S, et al. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum. 2022;
Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2021;388:2532–61. DOI: https://doi.org/10.1016/S0140-6736(16)31357-5
Ridker P, Everett B, Thuren T, MacFadyen J, Chang W, Ballantyne C, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J. 2023;377:1119–31. DOI: https://doi.org/10.1056/NEJMoa1707914
Zelniker T, Wiviott SRI, Im K, Goodrich E, Bonaca M, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2023;393:31–9. DOI: https://doi.org/10.1016/S0140-6736(18)32590-X
Scheltens P, De Strooper B, Kivipelto M, Holstege H, Chételat G, Teunissen C, et al. Alzheimer’s disease. Lancet. 2021;397:1577–90. DOI: https://doi.org/10.1016/S0140-6736(20)32205-4
Smolen J, Landewé R, Bijlsma J, Burmester G, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2023 update. Ann Rheum Dis. 2024;83:3–18.
Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2023;
Sabatine M, Giugliano R, Keech A, Honarpour N, Wiviott S, Murphy S, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2021;376:1713–22. DOI: https://doi.org/10.1056/NEJMoa1615664
Ray K, Wright R, Kallend D, König W, Lesogor A, Landmesser U, et al. Two phase 3 trials of inclisiran in patients with elevated LDL cholesterol. N Engl J Med. 2022;382:1507–19. DOI: https://doi.org/10.1056/NEJMoa1912387
Marso S, Bain S, Consoli A, Eliaschewitz F, Jódar E, Leiter L, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2021;375:1834–44. DOI: https://doi.org/10.1056/NEJMoa1607141
Jastreboff A, Aronne L, Ahmad N, Wharton S, Connery L, Alves B, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2023;387:205–16. DOI: https://doi.org/10.1056/NEJMoa2206038
Packer M, Anker S, Butler J, Filippatos G, Pocock S, Carson P, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2022;383:1413–24. DOI: https://doi.org/10.1056/NEJMoa2022190
Heerspink H, Stefánsson B, Correa-Rotter R, Chertow G, Greene T, Hou F, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2021;383:1436–46. DOI: https://doi.org/10.1056/NEJMoa2024816
McInnes I, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2022;365:2205–19. DOI: https://doi.org/10.1056/NEJMra1004965
Feuerstein J, Ho E, Shmidt E, Singh H, Falck-Ytter Y, Sultan S, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2023;158:1450–61. DOI: https://doi.org/10.1053/j.gastro.2020.01.006
Smith S, Carris N, Radosevich E. Incretin-based therapies and cardiovascular risk reduction: an updated meta-analysis of randomized controlled trials. J Clin Med. 2024;13:942–55.
Turner J, Edwards S, Bell J. Deprescribing in older adults with chronic multi-morbidity: a review of current evidence and challenges. Therapeutic Adv Drug Saf. 2022;13:1–15.
López-Samaniego L, Esteva-Mendez M. Iatrogenia por guías clínicas: el reto de la pluripatología en el paciente anciano. Rev Esp Geriatr Gerontol. 2025;60:89–96.
Lapi F, Azoulay L, Yin H, Nessim S, Suissa S. Concurrent use of non-steroidal anti-inflammatory drugs with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and diuretics, and the risk of acute kidney injury: nested case-control study. BMJ. 2023;346:e8525. DOI: https://doi.org/10.1136/bmj.e8525
Chang W, Juo S, Tsai W. Pharmacogenomics in cardiovascular medicine: current state and future implementation. Front Pharmacol. 2024;15:789–801.
Pirmohamed M. https://doi.org/10.1016/j.cell.2023.03.033. Personalized medicine: the future of pharmacotherapy. 2023;186:2115–27.
Gomez-Vasquez J, Ramirez-Duque M. Desafíos económicos de la medicina de precisión en América Latina. Rev Panam Salud Publica. 2025;49:e34.
Brown M, Bussell J. Medication adherence: WHO cares? Mayo Clin Proc. 2021;86:304–14. DOI: https://doi.org/10.4065/mcp.2010.0575
Patel S, Twigg M. The psychology of medication non-adherence in chronic illness: a systematic review of qualitative behavioral models. Patient Educ Couns. 2026;114:107–18.
