FARMACOTERAPIA DEL TRASTORNO POR DÉFICIT DE ATENCIÓN CON HIPERACTIVIDAD EN ADULTOS: UNA REVISIÓN SISTEMÁTICA CON METAANÁLISIS DE ENSAYOS CLÍNICOS ALEATORIZADOS (2015-2025)
DOI:
https://doi.org/10.56238/levv17n60-025Palabras clave:
TDAH, Adultos, Metilfenidato, Lisdexanfetamina, Atomoxetina, Guanfacina, Metaanálisis, Ensayo Clínico AleatorizadoResumen
Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) afecta aproximadamente al 2,5 % de la población adulta mundial. Existen múltiples agentes farmacológicos disponibles, pero los datos comparativos de eficacia y seguridad siguen siendo limitados. Objetivo: Revisar sistemáticamente y realizar un metaanálisis de la eficacia, seguridad y tolerabilidad de los tratamientos farmacológicos para el TDAH en adultos utilizando ensayos controlados aleatorizados (ECA) publicados entre 2015 y 2025. Métodos: Se realizaron búsquedas sistemáticas en PubMed/MEDLINE, Embase y la Biblioteca Cochrane de ECA doble ciego, controlados con placebo en adultos (≥18 años) con TDAH diagnosticado según DSM-IV, DSM-5 o CIE-10/11. El resultado primario fue la reducción de los síntomas medida por escalas validadas (ADHD-RS, Conners, SNAP-IV). Los resultados secundarios incluyeron eventos adversos, tasas de interrupción y mejora funcional. El riesgo de sesgo se evaluó utilizando Cochrane RoB 2.0. El metaanálisis empleó modelos de efectos aleatorios con diferencias de medias estandarizadas (DME) e intervalos de confianza del 95 % (IC del 95 %). La heterogeneidad se evaluó mediante el estadístico I². Se aplicó la metodología GRADE para evaluar la calidad de la evidencia. Resultados: Se incluyeron treinta y siete ECA (n = 2289 adultos). El metilfenidato de liberación prolongada demostró el mayor tamaño del efecto (DME: -0,92; IC del 95%: -1,08 a -0,76), seguido de la lisdexanfetamina (DME: -0,96; IC del 95%: -1,17 a -0,76), las sales mixtas de anfetamina (DME: -0,81; IC del 95%: -0,95 a -0,67) y la atomoxetina (DME: -0,48; IC del 95%: -0,64 a -0,33). La guanfacina mostró una eficacia moderada (DME: -0,66; IC del 95%: -0,94 a -0,38). Los estimulantes demostraron una aceptabilidad superior en comparación con los no estimulantes. Los eventos adversos fueron generalmente leves y dependientes de la dosis. La heterogeneidad fue moderada (I²: 30-50%). Conclusión: Los medicamentos estimulantes, en particular el metilfenidato y la lisdexanfetamina, representan los tratamientos farmacológicos de primera línea para el TDAH en adultos, con efectos de gran magnitud y perfiles de tolerabilidad favorables. Los fármacos no estimulantes ofrecen alternativas para pacientes con contraindicaciones o comorbilidades. La calidad de la evidencia varía de moderada a alta para los estimulantes y de baja a moderada para los no estimulantes.
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