Review Compares Effectiveness of Tocolytic Agents

Prostaglandin inhibitors and calcium channel blockers most effective for delaying delivery

WEDNESDAY, Oct. 10 (HealthDay News) -- The most effective tocolytic agents for delaying delivery and improving neonatal and maternal outcomes are prostaglandin inhibitors and calcium channel blockers, according to a meta-analysis published online Oct. 9 in BMJ.

David M. Haas, M.D., from the Indiana University School of Medicine in Indianapolis, and colleagues conducted a systematic review and network meta-analysis to assess the most effective tocolytic agent for delaying delivery.

Of 3,263 titles identified, 95 randomized controlled trials were reviewed. The researchers found that the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio [OR], 5.39), followed by magnesium sulfate (OR, 2.76); calcium channel blockers (OR, 2.71); beta mimetics (OR, 2.41); and atosiban, the oxytocin receptor blocker (OR, 2.02), compared with placebo. Side effects necessitating a change of medication were significantly higher for beta mimetics (OR, 22.68), magnesium sulfate (OR, 8.15), and calcium channel blockers (OR, 3.80), compared with placebo. For the outcomes of 48-hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects, the tocolytics with the best probability of being ranked in the top three medication classes were prostaglandin inhibitors and calcium channel blockers.

"In this network meta-analysis, prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal outcomes," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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