Atosiban for Threatened Premature Labor: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 RANJing , HUANGHui-ping , CHENQiong-hua , YANGHong-yi , QIUNa-xuan ,  CHENDa-hong

Department of Gynaecology and Obstetrics, The First Hospital of Xiamen University, Xiamen 361000, China;

Corresponding author：

CHENDa-hong, Email: zsycdh@yahoo.cn

Keywords：

Atosiban; Threatened premature labor; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140015

Video：

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Objective To systematically review the effectiveness and safety of atosiban in the treatment of threatened premature labor. Methods We electronically searched databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI, WanFang Data and VIP for randomized controlled trials (RCTs) on atosiban for threatened premature labor from inception to October 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 11 RCTs involving 2 542 cases of threatened preterm labor were included. The results of meta-analyses showed that atosiban was superior to β₂ adrenergic receptor agonists in effectiveness (48 h:OR=1.33, 95%CI 1.06 to 1.66, P=0.01; 7 d:OR=1.36, 95%CI 1.12 to 1.65, P=0.002) and maternal tolerability (48 h:OR=1.65, 95%CI 1.34 to 2.06, P < 0.01; 7 d:OR=1.65, 95%CI 1.34 to 2.02, P < 0.01), but its effectiveness was similar to calcium antagonists (48 h:OR=0.94, 95%CI 0.55 to 1.60, P=0.82; 7 d:OR=0.92, 95%CI 0.53 to 1.60, P=0.77). There were no significant differences in gestational age (MD=0.20, 95%CI-0.16 to 0.56, P=0.27), the incidence of cardiovascular adverse effects in the mother's body (OR=0.07, 95%CI 0.01 to 1.05, P=0.05), birth weight (MD=-13.20, 95%CI-77.84 to 51.44, P=0.69), and the incidences of asphyxia (OR=2.08, 95%CI 0.89 to 4.87, P=0.09), sepsis (OR=0.78, 95%CI 0.54 to 1.14, P=0.20) and respiratory distress syndrome (OR=1.03, 95%CI 0.65 to 1.65, P=0.89) between the atosiban and β₂ adrenergic receptor agonist groups. But its incidence of cardiovascular adverse effects in the mother's body was significantly lower than calcium antagonists (OR=0.001 4, 95%CI 0.02 to 0.82, P=0.05). Conclusion Atosiban is better than other tocolytics in controlling the uterine contraction, and it could significantly prolong gestational age, with less maternal side effects and more tolerability. It is safer than other tocolytics in the treatment of threatened premature labor. It could be used as a first-line drug for the treatment of acute preterm contractions because of its high specificity in the uterus.

Citation： RANJing, HUANGHui-ping, CHENQiong-hua, YANGHong-yi, QIUNa-xuan, CHENDa-hong. Atosiban for Threatened Premature Labor: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(1): 85-93. doi: 10.7507/1672-2531.20140015 Copy

1.	Ingemarsson I, Lamont RF. An update on the controversies of tocolytic therapy for the prevention of preterm birth. Acta Obstet Gynecol Scand, 2003, 82(1):1-9.
2.	Oei SG. Calcium channel blockers for tocolysis:a review of their role and safety following reports of serious adverse events. Eur J Obstet Gynecol Reprod Biol, 2006, 126(2):137-145.
3.	Shim JY, Park YW, Yoon BH, et al. Multicentre, parallel group, randomised, single-blind study of the safety and efficacy of atosiban versus ritodrine in the treatment of acute preterm labour in Korean women. BJOG, 2006, 113(11):1228-1134.
4.	Vaast P, Dubreucq-Fossaert S, Houfflin-Debarge V, et al. Acute pulmonary oedema during nicardipine therapy for premature labour; Report of five cases. Eur J Obstet Gynecol Reprod Biol, 2004, 113(1):98-99.
5.	Husslein P, Quartarolo JP. Review of clinical experience with atosiban and the Tractocile Efficacy Assessment Survey in Europe (TREASURE) study protocol. Int J Clin Pract, 2003, 57(2):121-127.
6.	Husslein P, Cabero RL, Dudenhausen JW, et al. Atosiban versus usual care for the management of preterm labor. J Perinat Med, 2007, 35(4):305-313.
7.	Moutquin JM, Sherman D, Cohen H, et al. Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor:a multicenter effectiveness and safety study. Am J Obstet Gynecol, 2000, 182(5):1191-1199.
8.	Lin CH, Lin SY, Shyu MK, et al. Randomized trial of oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of spontaneous preterm labor in Taiwanese women. J Formos Med Assoc, 2009, 108(6):493-501.
9.	Moutquin JM, Fontain JY, Dansereau J, et al. Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. The Worldwide Atosiban versus Beta-agonists Study Group. BJOG, 2001, 108(2):133-142.
10.	Nicholas M, Andrew A, Alan D, et al. 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(5):413-422.
11.	Nonnenmacher A, Hopp H, Dudenhausen J. Effectiveness and safety of atosiban vs. pulsatile administration of fenoterol in the treatment of preterm labour. Z Geburtshilfe Neonatol, 2009, 213(5):201-206.
12.	Cabrol D, Gillet JY, Madelenat P, et al. Treatment of preterm labor with the oxytocin antagonist atosiban:a double-blind, randomized, controlled comparison with salbutamol. Eur J Obstet Gynecol Reprod Biol, 2001, 98(2):177-185.
13.	Romero R, Sibai BM, Sanchez-Ramos L, et al. 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(5):1173-1183.
14.	Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipin for the treatment of preterm labor. Int J Gynaecol Obstet, 2005, 91(1):10-14.
15.	Al-Omari WR, Al-Shammaa HB, Al-Tikriti EM, et al. Atosiban and nifedipine in acute tocolysis:a comparative study. Eur J Obstet Gynecol Reprod Biol, 2006, 128(1-2):129-134.
16.	Salim R, Garmi G, Nachum Z, et al. Nifedipine compared with atosiban for treating preterm labor:a randomized controlled trial. Obstet Gynecol, 2012, 120(6):1323-1331.
17.	van Geijn HP, Lenglet JE, Bolte AC. Nifedipine trials:effectiveness and safety aspects. BJOG, 2005, 112(Suppl):179-183.
18.	Nakajima Y, Masaoka N, Tsuduki Y, et al. Rhabdomyolysis caused by tocolytic therapy with oral ritodrine hydrochloride in a pregnant woman with placenta previa. J Obstet Gynaecol Res, 2011, 37(6):629-632.
19.	Shiba M, Kido K, Umezawa K, et al. Erythematous and bullous rash strongly indicating toxic epidermal necrolysis associated with the use of intravenous ritodrine hydrochloride. J Obstet Gynaecol Res, 2010, 36(3):676-680.
20.	Yasuda R, Makino Y, Matsuda Y, et al. Agranulocytosis associated with intravenous ritodrine hydrochloride therapy:two case reports by different mechanisms. J Obstet Gynaecol Res, 2012, 38(3):574-577.
21.	Wex J, Abou-Setta AM, Clerici G, et al. Atosiban versus betamimetics in the treatment of preterm labour in Italy:clinical and economic importance of side-effects. Eur J Obstet Gynecol Reprod Biol, 2011, 157(4):128-135.
22.	吴远萍, 张少璇, 王雪云.醋酸阿托西班治疗先兆早产的疗效观察及护理.中国实用医药, 2010, 5(19):182-183.
23.	Higgins JPT, Altman DG, Sterne JAC, et al. Charpter 8:Assessing risk of bias in included studies. In:Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collabration, 2011. Available from:www.cochrane-handbook.org.

1. Ingemarsson I, Lamont RF. An update on the controversies of tocolytic therapy for the prevention of preterm birth. Acta Obstet Gynecol Scand, 2003, 82(1):1-9.
2. Oei SG. Calcium channel blockers for tocolysis:a review of their role and safety following reports of serious adverse events. Eur J Obstet Gynecol Reprod Biol, 2006, 126(2):137-145.
3. Shim JY, Park YW, Yoon BH, et al. Multicentre, parallel group, randomised, single-blind study of the safety and efficacy of atosiban versus ritodrine in the treatment of acute preterm labour in Korean women. BJOG, 2006, 113(11):1228-1134.
4. Vaast P, Dubreucq-Fossaert S, Houfflin-Debarge V, et al. Acute pulmonary oedema during nicardipine therapy for premature labour; Report of five cases. Eur J Obstet Gynecol Reprod Biol, 2004, 113(1):98-99.
5. Husslein P, Quartarolo JP. Review of clinical experience with atosiban and the Tractocile Efficacy Assessment Survey in Europe (TREASURE) study protocol. Int J Clin Pract, 2003, 57(2):121-127.
6. Husslein P, Cabero RL, Dudenhausen JW, et al. Atosiban versus usual care for the management of preterm labor. J Perinat Med, 2007, 35(4):305-313.
7. Moutquin JM, Sherman D, Cohen H, et al. Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor:a multicenter effectiveness and safety study. Am J Obstet Gynecol, 2000, 182(5):1191-1199.
8. Lin CH, Lin SY, Shyu MK, et al. Randomized trial of oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of spontaneous preterm labor in Taiwanese women. J Formos Med Assoc, 2009, 108(6):493-501.
9. Moutquin JM, Fontain JY, Dansereau J, et al. Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. The Worldwide Atosiban versus Beta-agonists Study Group. BJOG, 2001, 108(2):133-142.
10. Nicholas M, Andrew A, Alan D, et al. 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(5):413-422.
11. Nonnenmacher A, Hopp H, Dudenhausen J. Effectiveness and safety of atosiban vs. pulsatile administration of fenoterol in the treatment of preterm labour. Z Geburtshilfe Neonatol, 2009, 213(5):201-206.
12. Cabrol D, Gillet JY, Madelenat P, et al. Treatment of preterm labor with the oxytocin antagonist atosiban:a double-blind, randomized, controlled comparison with salbutamol. Eur J Obstet Gynecol Reprod Biol, 2001, 98(2):177-185.
13. Romero R, Sibai BM, Sanchez-Ramos L, et al. 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(5):1173-1183.
14. Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipin for the treatment of preterm labor. Int J Gynaecol Obstet, 2005, 91(1):10-14.
15. Al-Omari WR, Al-Shammaa HB, Al-Tikriti EM, et al. Atosiban and nifedipine in acute tocolysis:a comparative study. Eur J Obstet Gynecol Reprod Biol, 2006, 128(1-2):129-134.
16. Salim R, Garmi G, Nachum Z, et al. Nifedipine compared with atosiban for treating preterm labor:a randomized controlled trial. Obstet Gynecol, 2012, 120(6):1323-1331.
17. van Geijn HP, Lenglet JE, Bolte AC. Nifedipine trials:effectiveness and safety aspects. BJOG, 2005, 112(Suppl):179-183.
18. Nakajima Y, Masaoka N, Tsuduki Y, et al. Rhabdomyolysis caused by tocolytic therapy with oral ritodrine hydrochloride in a pregnant woman with placenta previa. J Obstet Gynaecol Res, 2011, 37(6):629-632.
19. Shiba M, Kido K, Umezawa K, et al. Erythematous and bullous rash strongly indicating toxic epidermal necrolysis associated with the use of intravenous ritodrine hydrochloride. J Obstet Gynaecol Res, 2010, 36(3):676-680.
20. Yasuda R, Makino Y, Matsuda Y, et al. Agranulocytosis associated with intravenous ritodrine hydrochloride therapy:two case reports by different mechanisms. J Obstet Gynaecol Res, 2012, 38(3):574-577.
21. Wex J, Abou-Setta AM, Clerici G, et al. Atosiban versus betamimetics in the treatment of preterm labour in Italy:clinical and economic importance of side-effects. Eur J Obstet Gynecol Reprod Biol, 2011, 157(4):128-135.
22. 吴远萍, 张少璇, 王雪云.醋酸阿托西班治疗先兆早产的疗效观察及护理.中国实用医药, 2010, 5(19):182-183.
23. Higgins JPT, Altman DG, Sterne JAC, et al. Charpter 8:Assessing risk of bias in included studies. In:Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collabration, 2011. Available from:www.cochrane-handbook.org.

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