Clinical practice evaluation of combination of atosiban, ritodrine and ketoprofen for inhibiting preterm labor.
OBJECTIVE
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 (6.75 mg initial dose, 300 microg/min loading dose for 3 hours, 100 microg/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 non delivered 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.


CONCLUSIONS
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.
Grignaffini
A
A
Department of Gynaecology, Obstetrics and Neonatology, University of Parma, Parma, Italy.
Soncini
E
E
Ronzoni
E
E
Lo Cane
F
F
Anfuso
S
S
Nardelli
G B
GB
D000328:Adult; D016022:Case-Control Studies; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007558:Italy; D007660:Ketoprofen / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000517:prevention & control*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012312:Ritodrine / Q000627:therapeutic use*; D015149:Tocolytic Agents / Q000627:therapeutic use*; D016896:Treatment Outcome; D014590:Uterine Contraction / Q000187:drug effects; D014668:Vasotocin / Q000031:analogs & derivatives* / Q000627:therapeutic use
D016861:Cyclooxygenase Inhibitors; D015149:Tocolytic Agents; C047046:atosiban; D007660:Ketoprofen; D012312:Ritodrine; D014668:Vasotocin