Resumen
Introducción: la esclerosis múltiple es una enfermedad crónica, neurodegenerativa y autoinmune del sistema nervioso central. En Colombia, se considera como la enfermedad huérfana-rara más común, con 3224 casos reportados entre los años 2016 y 2021. El tratamiento se basa en una variedad de terapias modificadoras de la enfermedad que busca reducir las recaídas, disminuir la actividad en imágenes y retrasar la progresión de la discapacidad; sin embargo, el manejo clínico presenta desafíos debido a la falta de definiciones claras sobre el fallo de las terapias modificadoras y la falta de guías claras para el cambio de tratamiento.
Objetivo: elaborar una definición de fallo terapéutico y diseñar un algoritmo para su manejo en pacientes con esclerosis múltiple recurrente en Colombia.
Materiales y métodos: se llevó a cabo un consenso de expertos mediante la metodología Delphi en dos rondas virtuales con diez expertos. Además, se hizo una revisión de la literatura para obtener información destinada al diseño de la definición y al algoritmo del fallo terapéutico.
Resultados: se elaboró una definición de fallo terapéutico compuesta por una introducción y la descripción de las variables clínicas que se utilizarán para determinar si un paciente presenta fallo terapéutico, y también se diseñó un algoritmo con una estrategia de optimización terapéutica, considerando las necesidades individuales de cada paciente según la definición diseñada previamente.
Conclusiones: se desarrolló una definición y un algoritmo de manejo específico para Colombia basados en evidencia, experiencia clínica y recomendaciones de expertos. Estas herramientas facilitarán la toma de decisiones, el seguimiento y la eficiencia de los tratamientos, y se actualizarán periódicamente para reflejar avances científicos y mejores prácticas.
Citas
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