D-Penicilamina versus sales de Zinc en el tratamiento de la enfermedad de Wilson

Abstract

Importance: This study compares D-penicillamine and zinc salts as initial treatment for Wilson’s disease, considering their impact on clinical progression, treatment adherence, and prevention of long-term complications. Objective: Which is the better treatment for Wilson’s disease: D-penicillamine or zinc salts? Methodology: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Eligibility criteria were used for study selection; searches were carried out in the Scopus and PubMed databases; and the RoB 2 and JBI tools were used to assess the risk of bias. Results: The review included 22 studies, and the findings show that both D-penicillamine and zinc salts are effective in reducing copper levels. However, zinc salts demonstrated a superior safety profile during the neurological phase, with fewer adverse effects compared with D-penicillamine. Discussion: Although the evidence presented limitations due to the risk of bias, small sample sizes, and heterogeneity among the studies, the results suggest that zinc salts may be a preferable treatment option due to their lower incidence of side effects. Conclusions: D-penicillamine is associated with a higher risk of adverse effects and neurological deterioration compared with zinc salts. Caution is recommended when applying these clinical findings, and further research is needed to optimize treatment selection is emphasized.