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Anticorpos monoclonais no tratamento da osteoporose pós-menopausa
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Abstract(s)
A osteoporose pós-menopáusica representa um desafio significativo para a saúde pública, caracterizando-se pela perda acelerada de massa óssea e pelo aumento do risco de fraturas. A presente revisão analisa o papel dos anticorpos monoclonais no tratamento desta doença, com especial enfoque no denosumabe e no romosozumabe, avaliando os respetivos mecanismos de ação, eficácia clínica e perfis de segurança.
O denosumabe, um inibidor do RANKL, tem-se revelado muito eficaz na redução de fraturas vertebrais (68%) e não vertebrais (40%), com uma administração semestral. O seu mecanismo antirreabsortivo proporciona aumentos sustentados na densidade mineral óssea, embora exija estratégias de transição terapêutica após a sua interrupção.
O romosozumabe, um anticorpo anti-esclerostina, destaca-se pela sua ação dupla, que consiste na estimulação da formação óssea e na inibição da reabsorção, sendo mais eficaz do que a teriparatida. No entanto, a sua utilização está limitada a 12 meses devido a potenciais riscos cardiovasculares.
Em comparação, os bifosfonatos continuam a ser a primeira opção em muitos casos, mas os anticorpos monoclonais oferecem alternativas superiores para doentes de alto risco ou com intolerância às terapias convencionais. A escolha do tratamento deve ter em conta fatores individuais, incluindo o risco de fratura, comorbilidades e as preferências do paciente.
Esta análise reforça a importância da medicina personalizada no tratamento da osteoporose, realçando o potencial transformador das terapias biológicas. Estudos futuros deverão explorar estratégias de otimização terapêutica e de ampliação do acesso a estas inovações.
Postmenopausal osteoporosis represents a significant public health challenge, characterized by accelerated bone mass loss and increased risk of fractures. This review analyzes the role of monoclonal antibodies in the treatment of this disease, with a special focus on denosumab and romosozumab, evaluating their respective mechanisms of action, clinical efficacy and safety profiles. Denosumab, a RANKL inhibitor, has proven to be very effective in reducing vertebral (68%) and non-vertebral (40%) fractures, with biannual administration. Its antiresorptive mechanism provides sustained increases in bone mineral density, although it requires therapeutic transition strategies after its discontinuation. Romosozumab, an anti-sclerostin antibody, stands out for its dual action, which consists of stimulating bone formation and inhibiting resorption, being more effective than teriparatide. However, its use is limited to 12 months due to potential cardiovascular risks. In comparison, bisphosphonates remain the first choice in many cases, but monoclonal antibodies offer superior alternatives for high-risk patients or those intolerant to conventional therapies. Treatment choice should take into account individual factors, including fracture risk, comorbidities, and patient preferences. This analysis reinforces the importance of personalized medicine in the treatment of osteoporosis, highlighting the transformative potential of biologic therapies. Future studies should explore strategies for therapeutic optimization and expanding access to these innovations.
Postmenopausal osteoporosis represents a significant public health challenge, characterized by accelerated bone mass loss and increased risk of fractures. This review analyzes the role of monoclonal antibodies in the treatment of this disease, with a special focus on denosumab and romosozumab, evaluating their respective mechanisms of action, clinical efficacy and safety profiles. Denosumab, a RANKL inhibitor, has proven to be very effective in reducing vertebral (68%) and non-vertebral (40%) fractures, with biannual administration. Its antiresorptive mechanism provides sustained increases in bone mineral density, although it requires therapeutic transition strategies after its discontinuation. Romosozumab, an anti-sclerostin antibody, stands out for its dual action, which consists of stimulating bone formation and inhibiting resorption, being more effective than teriparatide. However, its use is limited to 12 months due to potential cardiovascular risks. In comparison, bisphosphonates remain the first choice in many cases, but monoclonal antibodies offer superior alternatives for high-risk patients or those intolerant to conventional therapies. Treatment choice should take into account individual factors, including fracture risk, comorbidities, and patient preferences. This analysis reinforces the importance of personalized medicine in the treatment of osteoporosis, highlighting the transformative potential of biologic therapies. Future studies should explore strategies for therapeutic optimization and expanding access to these innovations.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Osteoporose pós-menopáusica Denosumabe Romosozumabe Anticorpos monoclonais Tratamento