Atosiban Versus Ritodrine in the Treatment of Preterm Labour: A Systematic Review

doi:10.3877/cma.j.issn.1673-5250.2014.02.010

Objective

To explore the clinical efficacy and safety between atosiban and ritodrine in treatment of preterm labour.

Methods

The relevant data base were searched according to the principles of systematic review to collect all the randomized controlled trials(RCT) involving treatment of preterm labour using atosiban and ritodrine. According to treatment strategies, the subjects were divided into atosiban group and ritodrine group. Meta-analysis of including studies was performed by Rev Man 5.1 software.

Results

A total of 4 pieces RCT were included with 420 subjects．①Three of them were English literature, RCT with high quality included patients of preterm labour．The Meta-analysis showed there were no statistic differences in tocolytic efficacy, gestational age at delivery, birth weight of neonatal, rates of neonatal asphyxia or perinatal death between two groups (P>0.05) ．The incidence of maternal tachycardia and early drug termination due to adverse events in atosiban group were substantially lower than those in ritodrine group [RR=0.02, 95% CI(0.01-0.08) , P<0.01; RR=0.03, 95% CI(0.01-0.15) , P<0.01], respectively．②One Chinese study with relatively lower quality included patients of threatened preterm labour．A descriptive analysis conducted independently showed that there were no significant differences between two groups in time-to-effect, prolonged pregnancy duration, tocolysis rate, full-term delivery rate, birth weight or adverse events rate (P>0.05) .

Conclusions

Atosiban treatment of preterm labour was better than that of ritodrine. There had difference between domestic and abroad studies in term of incidence of adverse events. It is quite necessary to perform more high-quality and large-scale RCT in combination with cost-effectiveness evaluation to assess the exact clinic value of atosiban in treatment of preterm labour more reliably.

Key words: Evaluation studies, Premature birth, Atosiban, Ritodrine, Systematic review

表1 纳入研究的方法学质量评价比较

Table 1 Comparison of methodology quality evaluation on included studies

纳入研究	随机分组	分配隐藏	盲法	失访和退出	基线比较	ITT	质量等级
Moutquin等^[5]，2000	清楚	充分	双盲	清楚	可比	有	A
Shim等^[6]，2006	清楚	充分	单盲	清楚	可比	有	A
Lin等^[7]，2009	清楚	否	非盲	清楚	可比	有	B
骆绮云等^[8],2012	不清楚	否	非盲	清楚	可比	无	B

表1 纳入研究的方法学质量评价比较

Table 1 Comparison of methodology quality evaluation on included studies

纳入研究	随机分组	分配隐藏	盲法	失访和退出	基线比较	ITT	质量等级
Moutquin等^[5]，2000	清楚	充分	双盲	清楚	可比	有	A
Shim等^[6]，2006	清楚	充分	单盲	清楚	可比	有	A
Lin等^[7]，2009	清楚	否	非盲	清楚	可比	有	B
骆绮云等^[8],2012	不清楚	否	非盲	清楚	可比	无	B

图1 治疗有效率的比较

Figure 1 Comparison of rates of tocolytic efficacy between atosiban group and ritodrine group

图2 平均分娩孕周的比较

Figure 2 Comparison of average gestational age at delivery between atosiban group and ritodrine group

图3 新生儿平均出生体质量的比较

Figure 3 Comparison of average neonatal birth weight between atosiban group and ritodrine group

图4 新生儿转NICU率的比较

Figure 4 Comparison of rates of neonatal NICU admission between atosiban group and ritodrine group

图5 孕妇心动过速发生率比较

Figure 5 Comparison of rates of maternal tachycardia between atosiban group and ritodrine group

图6 因不良反应中断治疗率比较

Figure 6 Comparison of rates of drug termination due to adverse events between atosiban group and ritodrine group

表2 利托君与阿托西班治疗先兆早产效果及安全性比较（±s）

Table 2 Comparison of efficacy and safety in treatment threatened premature labor between atosiban group and ritodrine group （±s）

组别	n	显效时间(min)	延长妊娠时间(d)	保胎成功率[n(%)]	足月分娩率[n(%)]	新生儿出生体质量(g)	不良反应发生率[n(%)]
利托君	40	42.6±8.2	25.9±9.5	37(92.5)	30(75.0)	2751±363.6	6(15.0)
阿托西班	30	40.8±7.1	27.1±6.3	28(93.3)	22(73.3)	2813±266.0	3(10.0)
χ²/t		0.964	0.601	0.000	0.025	1.250	0.066
P		>0.1	>0.25	1.000	0.875	>0.1	0.797

表2 利托君与阿托西班治疗先兆早产效果及安全性比较（±s）

Table 2 Comparison of efficacy and safety in treatment threatened premature labor between atosiban group and ritodrine group （±s）

组别	n	显效时间(min)	延长妊娠时间(d)	保胎成功率[n(%)]	足月分娩率[n(%)]	新生儿出生体质量(g)	不良反应发生率[n(%)]
利托君	40	42.6±8.2	25.9±9.5	37(92.5)	30(75.0)	2751±363.6	6(15.0)
阿托西班	30	40.8±7.1	27.1±6.3	28(93.3)	22(73.3)	2813±266.0	3(10.0)
χ²/t		0.964	0.601	0.000	0.025	1.250	0.066
P		>0.1	>0.25	1.000	0.875	>0.1	0.797

[1]	Mercer BM，Merlino AA．Magnesium sulfate for preterm labour and preterm birth[J]．Obstetric Gynecol，2009，114(3):650-658．
[2]	中华医学会妇产科学会产科学组．早产的临床诊断与治疗推荐指南(草案)[M]．中华妇产科杂志，2007, 42(7):498-500．
[3]	Ananth CV，Joseph KS，Oyelese Y，et al．Trends in preterm birth and perinatal mortality among singletons：United States，1989 through 2000[J]．Obstet Gynecol，2005，105(5Ptl):1084-1091．
[4]	边旭明，付晨薇．早产的定义分类和诊断[J]．现代妇产科进展，2011，20(3):164-165．
[5]	Moutquin JM，Sherman D，Cohen H，et al．Double blind，randomized，controlled trial of atosiban and ritodrine in the treatment of preterm labor：Amulticenter effectiveness and safety study[J]．Am J Obstet Gynecol，2000，182(5):1191-1199．
[6]	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[J]．BJOG，2006，113(11):1228-1234．
[7]	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]． J Formos Med Assoc，2009，108(6):493-501．
[8]	骆绮云，蒙顺好等．3种宫缩抑制剂治疗先兆早产的临床疗效分析[J]．现代医药卫生，2012，28(7):969-970．
[9]	Wex J，Connolly M，Rath W．Atosiban versus betamimetics in the treatment of preterm labour in Germany：An economic evaluation．BMC Pregnancy Childbirth，2009，9(1):23．
[10]	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[J]．Eur J Obstet Gynecol Reproduc Bio，2011，157(2):128-135．
[11]	Rao AK，Cheng YW，Caughey AB．Perinatal complications among different Asian-American subgroups．Am J ObstetGynecol，2006，194:e39-41．
[12]	Rao AK，Daniels K，El-Sayed YY，et al．Perinatal outcomes among Asian American and Pacific Islander women [J]．Am J Obstet Gynecol，2006，195(7):834-838．
[13]	Patel RR，Steer P，Doyle P，et al．Does gestation vary by ethnic group? A London-based study of over 122，000 preg-nancies with spontaneous onset of labour[J]．Int J Epidemiol，2004，33(1):107-113．
[14]	Robertson PA，Sniderman SH，Laros RK Jr，et al．Neonatal morbidity according to gestational age and birth weight from five tertiary care centers in the United States，1983 through 1986[J]． Am J Obstet Gynecol，1992，166(15):1629-1645．

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