Atosiban efficacy and safety in pregnant women with threatened preterm delivery: systematic review of the literature with network meta-analysis
DOI:
https://doi.org/10.18597/rcog.3086Keywords:
Preterm labor, meta-analysis, nifedipine, indomethacin, terbutaline, fenoterol, placebos, medication-associated adverse reactionsAbstract
Objective: To assess the efficacy and safety of atosiban in pregnant women with risk of preterm delivery as compared to nifedipine, indomethacin, terbutaline, fenoterol and placebo.
Materials and methods: A systematic literature review was carried out in eight electronic databases, including Medline, Central, and Embase, using free and standardized search terms. Outcomes assessment included time delay until delivery, neonatal mortality, ratio of adverse maternal events, and ratio of neonatal complications. The quality of the evidence was evaluated per study and for the body of evidence and, whenever feasible, the information was synthesized into a meta-analysis. Alternatively, a narrative summary was presented.
Results: Eleven studies were included. Atosiban did not show any statistically significant differences in terms of delaying delivery versus other uterine contraction inhibitors. The neonatal mortality was lower compared to indomethacin (RR = 0.21; 95% CI: 0.05 to 0.92), and the percentage of total maternal adverse events was lower with fenoterol (RR = 0.16; 95% CI: 0.08 to 0.31), nifedipine (RR = 0.48; 95% CI: 0.3 to 0.78), and terbutaline (RR = 0.44; 95% CI: 0.28 to 0.71).
Conclusions: Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents (moderate certainty), showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).Author Biographies
Lina Salazar-Castelblanco
Paula Restrepo-Jiménez
Pieralessandro Lasalvia
Camilo Castañeda-Cardona
Diego Rosselli
Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá (Colombia). diego.rosselli@gmail.com
References
Iragorri V, Rodríguez Donado A, Perdomo Suarez D. Guía de manejo de trabajo de parto pretérmino. Secretaría Distrital de Salud. Bogotá: Asociación Bogotana de Obstetricia y Ginecología; 2013.
Lamont CD, Jørgensen JS, Lamont RF. The safety of tocolytics used for the inhibition of preterm labour. Expert Opin Drug Saf. 2016;15:1163-73. https://doi.org/10.1080/14740338.2016.1187128
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162-72. https://doi.org/10.1016/S0140-6736(12)60820-4
Beck S, Wojdyla D, Say L, Pilar Bertran A, Meraldi M, Harris Requejo J, et al. The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88:31-8. https://doi.org/10.2471/BLT.08.062554
Departamento Administrativo Nacional de Estadística (DANE). Nacimientos 2016; 2017.
Voto L, Valenti E, Asprea I, Voto G, Votta R. Parto pretérmino. FAGO. 2014;13:5-10.
Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365:891-900.
Fellman V, Hellström-Westas L, Norman M, Westgren M, Källén K, Lagercrantz H, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. Jama. 2009;301:2225-33. https://doi.org/10.1001/jama.2009.771
Odibo IN, Bird TM, McKelvey SS, Sandlin A, Lowery C, Magann EF. Childhood respiratory morbidity after late preterm and early term delivery: A study of medicaid patients in South Carolina. Paediatr Perinat Epidemiol. 2016;30:67-75. https://doi.org/10.1111/ppe.12250
Mendoza AL, Claros DI, Mendoza LI, Arias MD, Pe-aranda CB. Epidemiología de la prematuridad, sus determinantes y prevención del parto prematuro. Rev Chil Obs Ginecol. 2016;81:330-42. https://doi.org/10.4067/S0717-75262016000400012
Sociedad Española de Ginecología y Obstetricia. Amenaza de parto pretérmino. Progresos Obstet y Ginecol. 2012;55:347-66.
Kam KYR, Lamont RF. Developments in the pharmacotherapeutic management of spontaneous preterm labor. Expert Opin Pharmacother. 2008;9:1153-68. https://doi.org/10.1517/14656566.9.7.1153
Lamont RF. The development and introduction of anti-oxytocic tocolytics. BJOG An Int J Obstet Gynaecol. 2003;110:108-12. https://doi.org/10.1046/j.1471-0528.2003.00055.x
Schleußner E. The prevention, diagnosis and treatment of premature labor. Dtsch Ärzteblatt Int. 2013;110:227-35; quiz 236.
Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928-d5928.
Schuneman H, Brozek J, Guyatt G, Oxman A. GRADE Handbook. 2013 (visitado 2018 oct 31). Disponible en: https://gdt.gradepro.org/app/handbook/handbook.html
Brignardello-Petersen R, Bonner A, Alexander PE, Siemieniuk RA, Furukawa TA, Rochwerg B, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018;93:36-44. https://doi.org/10.1016/j.jclinepi.2017.10.005
Higgins J, Green S. 9.5.2 Identifying and measuring heterogeneity. 2011 (visitado 2018 oct 31). Disponible en: https://handbook-5-1.cochrane.org/chapter_9/9_5_2_identifying_and_measuring_heterogeneity.htm
Ministerio de Salud y Protección Social. Resolución 8430 de 1993.
Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipin for the treatment of preterm labor. Int J Gynaecol Obstet. 2005;91:10-4. https://doi.org/10.1016/j.ijgo.2005.06.005
Nonnenmacher A, Hopp HDJ. Wirksamkeit und sicherheit von Atosiban vs. pulsatiler applikation von fenoterol bei der behandlung vorzeitiger wehen. Z Geburtshilfe Neonatol. 2009;213:201-6. https://doi.org/10.1055/s-0029-1225640
Romero R, Sibai B, Sanchez-Ramos L, Valenzuela G, Veille J, Tabor B. An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: A randomized, double-blind, placebo-controlled trial with tocolytic rescue. Am J Obstet Gynecol. 2000;182:1173-83. https://doi.org/10.1067/mob.2000.95834
Salim R, Garmi G, Nachum Z, Zafran N, Baram S, Shalev E. Nifedipine compared with atosiban for treating preterm labor: A randomized controlled trial. Obstet Gynecol. 2012;120:1323-31. https://doi.org/10.1097/AOG.0b013e3182755dff
van Vliet E, Nijman T, Schuit E, Heida KY, Opmeer BC, Kook M. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): A multicentre, randomized controlled trial. Lancet. 2016;387:2117-24. https://doi.org/10.1016/S0140-6736(16)00548-1
European Atosiban Study Group. The oxytocin antagonist atosiban versus the beta-agonist terbutaline in the treatment of preterm labor. A randomized, double-blind, controlled study. Acta Obstet Gynecol Scand. 2001;80:413-22.
Cabar FR, Bittar RE, Gomes CM, Zugaib M. O atosibano como agente tocolítico: Uma nova proposta de esquema terapêutico. Rev Bras Ginecol Obstet. 2008;30:87-92. https://doi.org/10.1590/S0100-72032008000200007
Klauser C, Briery C, Keiser S, Martin R, Kosek M, Morrison J. Effect of antenatal tocolysis on neonatal outcomes. J Matern Fetal Neonatal Med. 2012;25:2778-81. https://doi.org/10.3109/14767058.2012.714819
Mawaldi L, Duminy P, Tamim H. Terbutaline versus nifedipine for prolongation of pregnancy in patients with preterm labor. Int J Gynaecol Obstet. 2008;100:65-8. https://doi.org/10.1016/j.ijgo.2007.06.047
Valdés E, Salinas H, Toledo V, Lattes K, Cuellar E, Perucca E, et al. Nifedipine versus fenoterol in the management of preterm labor: A randomized, multicenter clinical study. Gynecol Obstet Invest. 2012;74:109-15. https://doi.org/10.1159/000338856
Weerakul W, Chittacharoen A, Suthutvoravut S. Nifedipine versus terbutaline in management of preterm labor. Int J Gynaecol Obstet. 2002;76:311-3. https://doi.org/10.1016/S0020-7292(01)00547-1
Page A, Page GH. Tocolysis in 2016: An evidence-based clinical review. Int J Obstet Gynaecol Res. 2016;3:462-73.
Flenady V, Reinebrant HE, Liley HG, Tambimuttu EG, Papatsonis DNM. Oxytocin receptor antagonists for inhibiting preterm labour (review). Cochrane Database Syst Rev. 2014;3(6)
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Revista Colombiana de Obstetricia y Ginecología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
