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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2007 October;59(5):481-9
Clinical practice evaluation of combination of atosiban, ritodrine and ketoprofen for inhibiting preterm labor
Grignaffini A., Soncini E., Ronzoni E., Lo Cane F., Anfuso S., Nardelli G. B.
Department of Gynaecology, Obstetrics and Neonatology, University of Parma, Parma, Italy
Aim. The aim of this study was to compare the efficacy and tolerability of atosiban vs ritodrine administered as single-drug or as combination therapy with the COX inhibitor ketoprofen in the treatment of preterm labor and to investigate how frequent is the need for combination therapy with ketoprofen.
Methods. Ninety-one women with diagnosis of threatened preterm delivery at 24-33 weeks’ gestation were enrolled in an observational case-control study. Forty-seven received IV atosiban (6.75mg initial dose, 300 Ìg/min loading dose for 3 hours, 100 Ìg/min maintenance dose for 48-96 hours) and 44 IV ritodrine (0.05-0.3 mg/min). When response to the first drug in the first 2-4 hours was unsatisfactory, ketoprofen was added (100 mg loading dose IV and 100-150 mg maintenance dose every 12 hours) for a maximum of 48 hours.
Results. Ketoprofen was added in 51.1% of the atosiban group and 47.7% of the ritodrine group (P 0.75, not statistically significant). The percentages of women undelivered in the two groups were 85.1% vs 81.8% at 48 hours (P=0.44) and 59.6% vs 54.5% at 7 days (P=0.39). One woman treated with atosiban reported transient dyspnea at the administration of the bolus dose; 20.5% of women who received ritodrine developed tachycardia and 4.5% dyspnea (P=0.001). Neonatal mortality and morbidity were comparable in both groups and unrelated to ketoprofen exposure.
Conclusion. Atosiban efficacy was comparable to ritodrine, but with a superior safety profile. A large proportion of women in both groups required second-line ketoprofen therapy, with comparable neonatal outcomes.