Opções Terapêuticas Emergentes no Tratamento da Psoríase em Placas na Forma Moderada a Grave
Resumo
A psoríase é uma doença inflamatória sistémica, crónica e recorrente, muito comum, que afeta a pele e/ou articulações. Tem diversas variantes clínicas, sendo a psoríase em placas ou vulgar, a mais comum. Cerca de 20% dos doentes apresenta a forma moderada a grave desta variante. Com o tratamento convencional, nalguns doentes existe ausência ou perda de eficácia, efeitos colaterais ou resposta insuficiente, pelo que nas últimas décadas, com o avanço dos conhecimentos da fisiopatologia da psoríase, foram desenvolvidos fármacos com alvos cada vez mais específicos. O objetivo deste trabalho é apresentar os novos tratamentos para a psoríase em placas moderada a grave, em adultos. Para a elaboração deste artigo foi realizada uma revisão de literatura na base de dados PubMed e ClinicalTrials.gov para informação acerca dos fármacos já aprovados, assim como resultados de ensaios clínicos das terapias sistémicas emergentes atualmente em fase III. Os inibidores do TNF-α, uma classe pioneira entre os biológicos aprovados para esta doença, têm sido utilizados desde há vários anos com sucesso. No entanto, também apresentam limitações, pelo que tem sido realizada uma investigação clínica focada na procura de novos alvos terapêuticos. A descoberta da participação da via IL-23/Th17 na psoríase abriu caminho para o desenvolvimento de novos fármacos imunomoduladores, com resultados encorajadores que validam o papel pro-inflamatório desta via na doença. Também novos fármacos disponíveis por via oral, as “pequenas moléculas”, estão em desenvolvimento para o tratamento de psoríase. Na prática, não há um tratamento que seja o mais correto para todos os doentes com psoríase em placas moderada a grave, em termos de eficácia, segurança, regime de dosagem e via de administração. Apesar dos novos fármacos terem um longo caminho a percorrer até serem aprovados, eles representam uma promessa de tratamento mais direcionado, eficaz e seguro, com menor interferência com outras funções biológicas e melhor controlo da doença.
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