Beta-agonist: a class effect? – The re-analysis of worldwide atosiban data
Beta-agonist: a class effect? – The re-analysis of worldwide atosiban data
 Dr. Jerry Chan
Institute of Reproductive & Developmental Biology and Centre for Fetal Care
Queen Charlotte’s Hospital, London, UK
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Biography
Dr. Jerry Chan graduated from Trinity College Dublin in 1997, obtaining his MRCOG in 2001. Appointed Clinical Research Fellow, Imperial College London in 2002, he is based at the Institute of Reproductive & Developmental Biology and Centre for Fetal Care, Queen Charlotte’s Hospital, working for Professor NM Fisk. Dr. Chan won the Young Investigator Award at the Scientific Congress, National Health Group, Singapore 2003, and the Travel Award for best abstract at the International Fetal Medicine and Surgery Society meeting 2004.
Abstract
The beta-agonists have been the cornerstone of the acute treatment of preterm labour over the past two decades. While they unequivocally reduce the odds of delivery within 48 hours and 7 days of treatment, their use has been hampered by substantial maternal and fetal side-effects. The notion that some beta-agonists may have a more favourable side-effect profile than others, has led to a number of small comparative trials which, in part, explains the various choice of drugs in different centres and countries. We recently reported the largest randomised controlled trial of tocolytic agents comparing atosiban with three different beta-agonists which showed comparable tocolytic effectiveness but far more maternal and fetal side-effects with each of the three beta-agonists. We then undertook a pragmatic comparison of the side-effect profiles of ritodrine, salbutamol and terbutaline from reanalysis of data obtained within three arms of this comparative trial against atosiban. The incidence of categorical side effects was similar with the three drugs, with the exception of the subjective symptom of palpitations (ritodrine 24.0%, terbutaline 5.0% and salbutamol 12.3%,
p=0.003). There were also some differences in fetal heart rate (p<0.001), maternal blood pressure
(p<0.001) and serum glucose levels (p<0.001), although these were small and clinically unimportant. Because beta-agonist side effects were common with all of the three drugs tested, choosing one beta-agonist over the other to minimise side effects has little rationale, especially now that safer licensed tocolytics, such as atosiban, are available.
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