Efeito da farmacoterapia na fibromialgia: uma overview de revisões sistemáticas
DOI:
https://doi.org/10.11606/issn.2317-0190.v29i3a178254Palavras-chave:
Doenças Reumáticas, Fibromialgia, Dor, Tratamento Farmacológico, Resultado do TratamentoResumo
Fibromialgia é um distúrbio de processamento da dor debilitante e crônico, em que a proporção de pacientes que obtêm bons resultados com a farmacoterapia é pequena. No entanto, escolher a melhor evidência disponível sobre a farmacoterapia pode otimizar os resultados clínicos do paciente. Objetivo: Esta overview teve como objetivo identificar em revisões sistemáticas os efeitos da farmacoterapia na fibromialgia, considerando a qualidade das revisões e a eficácia dos resultados. Métodos: Esta busca foi realizada em sete bases de dados: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus e IPA. A qualidade metodológica foi avaliada usando A MeaSurement Tool to Assess Systematic Reviews 2. O protocolo foi registrado no PROSPERO (CRD42018095943). Resultados: Um total de 63 revisões sistemáticas foram selecionadas após a leitura de textos completos, mas apenas 8 delas eram de qualidade moderada a alta e foram incluídas nesta overview. Todas as revisões incluídas foram publicadas em inglês, entre 2012 e 2018, realizaram meta-análises, utilizaram os critérios de diagnósticos do American College of Rheumatology (1990) para fibromialgia e avaliaram conjuntamente a melhora da dor, reações adversas e retiradas. A maioria das revisões incluiu apenas ensaios clínicos randomizados. Dos quatorze medicamentos abordados nas revisões sistemáticas avaliadas, duloxetina, milnaciprano e pregabalina mostraram evidências de melhora da dor (moderada: ≤30%) e de outros sintomas da fibromialgia como depressão e fadiga. No entanto, esses medicamentos apresentaram retiradas significativas devido a reações adversas (principalmente náusea, cefaleia, tontura e constipação). A taxa de abandono ao tratamento chegou a 36%. Conclusão: Poucos estudos apresentam evidências suficientes e de alta qualidade sobre o efeito dos medicamentos na fibromialgia, resultando na falta de apoio para os prescritores escolherem medicamentos que atendam aos critérios de necessidade, eficácia, segurança e adesão.
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