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La única española detrás del primer fármaco que reduce la progresión de la esclerosis múltiple: "Es un hito" Celia Oreja Guevara, neuróloga implicada en el estudio del tolebrutinib. Cedida por Celia Oreja-Guevara.
Más de 55.000 personas conviven con la esclerosis múltiple (EM) en España, y cada año se diagnostican unos 2.000 nuevos casos, según datos de la Sociedad Española de Neurología. Esta enfermedad autoinmune afecta al cerebro y la médula espinal , causando síntomas que varían en tipo y gravedad según las áreas del sistema nervioso central dañadas. Sus manifestaciones, además, evolucionan de manera diferente , lo que da lugar a diferentes formas de la enfermedad.
El 85% de los casos corresponden a la Esclerosis Múltiple remitente recurrente (EMRR). En este tipo, los pacientes experimentan brotes en los que aparecen síntomas nuevos o reaparecen los ya conocidos, con una duración de días o semanas. Estos episodios pueden desaparecer completamente o dejar alguna secuela.
Sin embargo, con el tiempo, para la mitad de los pacientes la enfermedad adopta una forma progresiva. Tras una fase inicial de brotes, estos desaparecen y se produce un empeoramiento de su discapacidad -pasan de tener una EM remitente recurrente a secundaria progresiva (EMPS)-.
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Hasta hace poco, estos pacientes enfrentaban un futuro incierto , sin tratamientos que detuvieran el avance de la enfermedad. Pero esto está a punto de cambiar. Por primera vez , un nuevo fármaco desarrollado por investigadores de todo el mundo promete ralentizar la progresión de la discapacidad. "Será un cambio de paradigma", asegura Celia Oreja-Guevara, única española involucrada en el estudio, durante una entrevista con la web de Informativos Telecinco con motivo del Día Nacional de la Esclerosis Múltiple.
Actualmente, los 16 tratamientos aprobados en España se centran en controlar los brotes mediante la reducción de la inflamación en el sistema nervioso central. Aunque no curan la enfermedad, sí disminuyen los síntomas, las lesiones e incluso la progresión en muchos casos, pero no en todos. "Nos dimos cuenta de que había pacientes que, incluso con tratamiento, empeoraban con los años . Tenían lo que llamamos una progresión silente, donde la enfermedad avanzaba sin que pudiéramos detenerla", indica Oreja-Guevara, también jefa de Sección de Neurología del Hospital Clínico San Carlos.
Celia Oreja Guevara, neuróloga implicada en el estudio del tolebrutinib. Cedida por Celia Oreja Guevara
Primer fármaco que retrasa la discapacidad en pacientes con EM La especialista, que forma parte del Comité Global del desarrollo de este medicamento explica que "el tratamiento, denominado tolebrutinib , es un inhibidor la BTK, una enzima, ya conocida porque se ha usado en otras patologías, que actúa sobre el sistema inmune. Va a ser la primera vez que vamos a actuar, no solo sobre las células que producen inflamación, sino sobre las células que producen progresión (la microglía, situada dentro del cerebro)".
Los resultados de su ensayo clínico en fase III, que se han presentado en el Congreso del Comité Europeo para el Tratamiento e Investigación de la Esclerosis Múltiple (ECTRIMS) el pasado septiembre, demuestran que este fármaco reduce la progresión de la discapacidad en un 31% a los seis meses en comparación con el placebo "Es una reducción considerable en pacientes que solo empeoraban, supone una mejoría en su calidad de vida", señala Oreja-Guevara, también Presidenta del Consejo Médico Asesor de Asociación Española de Esclerosis Múltiple (AEDEM-COCEMFE).
Además, realizaron un segundo estudio con otro perfil de pacientes, en este caso con EM remitente recurrente, es decir, con brotes y poca degeneración, frente al tratamiento con teriflunomida. "No demostró que redujera los brotes más que este, pero sí la progresión en un 27%. Por lo que, se confirma que este tratamiento reduce la progresión y degeneración de la enfermedad ", aclara.
"Hasta ahora se habían realizado unos ocho o nueve estudios en personas con esclerosis múltiple secundaria progresiva y siempre habían salido negativos. Los pacientes se quejaban de que no teníamos nada para ellos. Y era la verdad. No teníamos nada y ellos seguían empeorando, empeorando y empeorando, hasta acabar en silla de ruedas. No había ni una sola esperanza ". Hasta ahora . "Es un gran hito . Es un cambio de mentalidad. Es un gran éxito" , declara. "Esto es tan solo el principio. Este tratamiento abre el camino para que los próximos la reduzcan más".
¿Cuándo y quién podrá beneficiarse de este tratamiento? Este tratamiento, en formato de pastilla de administración diaria, "tiene indicaciones claras para los pacientes con secundaria progresiva que llevan sin brotes dos años, y se pretende que también se administre a los remitentes recurrentes con brotes que tengan inicios de degeneración y lleven con la enfermedad cinco o seis años", subraya.
Actualmente está en fase de evaluación de su seguridad y efectividad por la Administración de Alimentos y Medicamentos (FDA) y en enero llegará también a la Agencia Europea de Medicamentos (EMA), que podría aprobarlo a finales del 2025 .
Mirando a futuro, Oreja-Guevara espera que en unos años se puedan combinar los fármacos que traten los brotes con los que dirigidos a la degeneración, pero para eso "faltan los estudios que demuestren que la combinación no da más efectos secundarios", concluye.
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