Re: OOB: Meta-analysis of tocolysis FRI
From: art fougner, md (evsono@pipeline.com)
Wed Apr 22 13:41:28 2009
Does the involvement of the Dept of Gastroenterology mean some found the
conclusions hard to swallow?
Art
At Wed, 22 Apr 2009, DoctorJoe@aol.com wrote:
>
>Interesting study.
>
>Tocolytic therapy: a meta-analysis and decision analysis.
>
>Obstet Gynecol. 2009; 113(3):585-94
>
>OBJECTIVE: To determine the optimal first-line tocolytic agent for
>treatment of premature labor.
>
>METHODS: We performed a quantitative analysis of randomized controlled
>trials of tocolysis, extracting data on maternal and neonatal outcomes, and
>pooling rates for each outcome across trials by treatment. Outcomes were delay
>of delivery for 48 hours, 7 days, and until 37 weeks; adverse effects causing
>discontinuation of therapy; absence of respiratory distress syndrome; and
>neonatal survival. We used weighted proportions from a random-effects
>meta-analysis in a decision model to determine the optimal first-line tocolytic
>therapy. Sensitivity analysis was performed using the standard errors of the
>weighted proportions.
>
>RESULTS: Fifty-eight studies satisfied the inclusion criteria. A
>random-effects meta-analysis showed that all tocolytic agents were superior to placebo
>or control groups at delaying delivery both for at least 48 hours (53% for
>placebo compared with 75-93% for tocolytics) and 7 days (39% for placebo
>compared with 61-78% for tocolytics). No statistically significant differences
>were found for the other outcomes, including the neonatal outcomes of
>respiratory distress and neonatal survival. The decision model demonstrated that
>prostaglandin inhibitors provided the best combination of tolerance and
>delayed delivery. In a hypothetical cohort of 1,000 women receiving prostaglandin
>inhibitors, only 80 would deliver within 48 hours, compared with 182 for
>the next-best treatment.
>
>CONCLUSION: Although all current tocolytic agents were superior to no
>treatment at delaying delivery for both 48 hours and 7 days, prostaglandin
>inhibitors were superior to the other agents and may be considered the optimal
>first-line agent before 32 weeks of gestation to delay delivery.
>
>Department of Obstetrics & Gynecology, Division of Gastroenterology,
>Indiana University School of Medicine, Indianapolis, Indiana, USA.
>
>Joe P.
>
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
