Tocolysis with nifedipine or beta-adrenergic agonists: A meta-analysis

Objective: To clarify the relative efficacy of nifedipine and beta-agonists for tocolysis. Data Sources: The literature was searched in the following databases: MEDLI NE 1965-1998, Embase 1988-1998, Current Contents 1997-1998, and the Cochran e Database for 1998. We also sought unpublished trials and abstracts submit ted to major international congresses. Search terms were: "tocolysis," "nif edipine," "calcium channel blocker," "ritodrine," "terbutaline," and "salbu tamol." Methods of Study Selection: Randomized controlled trials comparing tocolysi s with nifedipine and beta-adrenergic agonists during preterm labor were re viewed. In cases with postrandomization exclusions, authors were contacted to obtain intent-to-treat results and to avoid analytical bias. We identifi ed 11 published and two unpublished randomized trials. Tabulation, Integration, and Results: Data were extracted by two reviewers and analyzed by a blinded biostatistician with RevMan 3.1 software from the Cochrane Collaboration. We analyzed nine relevant randomized controlled tr ials that included 679 patients. Meta-analysis showed that nifedipine was m ore effective than the beta-agonists in delaying delivery at least 48 hours [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03, 2.24], or over 3 4 weeks (OR 1.87, 95% CI 1.11, 3.15). The agents did not differ as to the i ncidence of deliveries after 37 weeks (OR 1.29, 95% CI 0.85, 1.96) or the n eonatal mortality rate (OR 1.51, 95% CI 0.63, 3.65). Treatment with nifedip ine was interrupted significantly less often because of side effects (OR 0. 12, 95% CI 0.05, 0.29) and led to better neonatal outcomes (fewer infants w ith respiratory distress syndrome: OR 0.57, 95% CI 0.37, 0.89) or transferr ed to neonatal intensive care units (OR 0.65, 95% CI 0.43, 0.97). Conclusion: With respect to neonatal outcome, nifedipine appears to be more effective than beta-agonists for tocolysis and should be considered for us e as a first-line tocolytic agent. (C) 2001 by The American College of Obst etricians and Gynecologists.