Atosiban: a comprehensive approach to preterm labour management

Bhupesh Dewan; Sanjaykumar Navale; Rishima Ganiga

doi:10.18203/2320-1770.ijrcog20243223

Authors

Bhupesh Dewan Department of Medical Services, Zuventus Healthcare Limited, Mumbai, Maharashtra, India
Sanjaykumar Navale Department of Medical Services, Zuventus Healthcare Limited, Mumbai, Maharashtra, India
Rishima Ganiga Department of Medical Services, Zuventus Healthcare Limited, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243223

Keywords:

Preterm labour, Atosiban, Tocolysis, Oxytocin-receptor antagonist, Preterm birth

Abstract

Preterm birth (PTB) continues to be a leading cause of neonatal mortality and long-term complications globally, reinforcing the need for effective and safe tocolytic treatments. Atosiban, an oxytocin receptor antagonist, has emerged as a pivotal intervention for managing spontaneous preterm labour (sPTL) due to its targeted mechanism and favourable safety profile. This is especially critical in regions like India, where there is a significant therapeutic gap in the availability of effective, safe, and cost-efficient tocolytic agents. Dosing regimens for Atosiban include a full course (48 hours), a brief course (14 hours), and a single bolus dose. The brief and bolus regimens are particularly advantageous in settings that prioritize shorter hospital stays or outpatient management, offering a more convenient and cost-effective approach. These regimens also provide the flexibility of repeat treatments if necessary, enhancing patient care adaptability. Extensive clinical studies have validated Atosiban's efficacy and safety across its various dosing regimens. Although Atosiban has a high initial cost compared to its alternatives, such as β2-agonists and calcium channel blockers, its superior safety profile and targeted action result in fewer maternal and fetal side effects, thereby reducing overall healthcare costs. The ability to manage sPTL with shorter regimens alleviates the strain on healthcare resources and minimizes the need for intensive neonatal care, with significant cost savings. Overall, Atosiban represents a valuable therapeutic option for managing preterm labour. Its proven efficacy, safety, and cost-effectiveness make it a preferred choice for tocolysis, particularly in high-risk pregnancies like those with diabetes or cardiac issues.

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References

Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. The Lancet. 2023;402(10409):1261-71.

Bhakoo ON, Kumar P. Current challenges and future prospects of neonatal care in India. The Ind J Pediat. 2013;80:39-49.

Coler BS, Shynlova O, Boros-Rausch A, Lye S, McCartney S, Leimert KB, et al. Landscape of preterm birth therapeutics and a path forward. J Clin Med. 2021;10(13):2912.

Lamont RF, Jørgensen JS. Safety and efficacy of tocolytics for the treatment of spontaneous preterm labour. Current Pharmaceutical Design. 2019;25(5):577-92.

Wex J, Abou-Setta AM, Clerici G, Di Renzo GC. Atosiban versus betamimetics in the treatment of preterm labour in Italy: clinical and economic importance of side-effects. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011;157(2):128-35.

Lamont RF, Kam KR. Atosiban as a tocolytic for the treatment of spontaneous preterm labour. Expert Rev of Obst Gynecol. 2008;3(2):163-74.

FOGSI Focus-Prevention of Pre-Term Labour – 2017 The Federation of Obstetric and Gynecological Societies of India. 2017. Available at: https://www.fogsi.org/wp-content/uploads/fogsi-focus/fogsi-focus-ptl.pdf. Accessed on 17th June, 2024

Coelho K, Gupta M. Role of isoxsuprine as a tocolytic agent in the management of preterm labor in Indian clinical practice. Int J Reprod Contracept Obstet Gynecol. 2024;13:483-91.

Di Renzo GC, Roura LC, European Association of Perinatal Medicine-Study Group on “Preterm Birth”. Guidelines for the management of spontaneous preterm labour

Tractocile 7.5 mg/ml concentrate for solution for infusion. Available at: medicines.org.uk. Accessed on 12th July 2024.

Koshimizu TA, Nakamura K, Egashira N, Hiroyama M, Nonoguchi H, Tanoue A. Vasopressin V1a and V1b receptors: from molecules to physiological systems. Physiological reviews. 2012;92(4):1813-64.

Grzesiak M, Wilczynski J. Preliminary report of 48-hours Atosiban administration in spontaneous preterm labour - Doppler blood flow assessment of placental and fetal circulation. Neuro Endocrinol Lett. 2013;34(7):681-6.

Åkerlund M, Carlsson AM, Melin P, Trojnar J. The effect on the human uterus of two newly developed competitive inhibitors of oxytocin and vasopressin. Acta obstetricia et gynecologica Scandinavica. 1985;64(6):499-504

Goodwin TM, Paul R, Silver H, Spellacy W, Parsons M, Chez R, Hayashi R, Valenzuela G, Creasy GW, Merriman R. The effect of the oxytocin antagonist atosiban on preterm uterine activity in the human. American J Obst Gynecol. 1994;170(2):474-8.

Goodwin TM, Valenzuela G, Silver H, Hayashi R, Creasy GW, Lane R. Treatment of preterm labour with the oxytocin antagonist Atosiban. American J Perinatol. 1996;13(03):143-6.

Dewan B, Shah D. The clinical experience of atosiban in preterm labour. British J Med Res. 2016;13(7):1-9.

Shaikh S, Mayekar R, Bhosale A, Nandanwar Y, Dewan B. Atosiban–Its impact on uterine activity in preterm labour. British J Med Res. 2016;18(2):1-8.

Dewan B, Shinde S. Acute Tocolysis Using a Single Bolus Dose of Atosiban for Preterm Labour Management: A Prospective Study. J Gynecol Obst. 2023;11(5):120-4.

Dewan B, Shinde S. Clinical safety and efficacy of atosiban brief duration 14-hour treatment regimen in delaying preterm labour. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2023;12(6):1862-5

Bhatt A. Initial experience with the oxytocin antagonist atosiban for preterm labour in a tertiary care centre: prospective observational cohort study Eur J Biomed Pharma Sci. 2021;8(6):470-6.

Gupta N, Jahan U, Shukla S, Usmani F. Study to evaluate the efficacy and safety of Atosiban in preterm labour in North Indian population. Int J Clin Obst Gynaecol. 2023;7(3):371-5.

Singh P, Singh S, Singh D, Thakur A, Dhakar JS, Singh TP. Study on Safety and Efficacy of Atosiban and Nifedipine in the Management of Threatened Preterm Labour. SSR Inst Int J Life Sci. 2024;10(2):5209-14.

Dewan B. Oxytocin antagonist Atosiban for the treatment of preterm labour: clinical trial evidence. London J Med Health Res. 2024;24(1):35-45.

Ganla KN, Vora PH, Choudhary RA, Ganla MK, Joshi P, Desai K. Multiple re-treatments with Atosiban, an oxytocin receptor antagonist helps to delay the preterm labour successfully. Acta Scientific Women's Health. 2021;3(5):2582-3205.

Khalil MA, Saad R, Ibrahim AA. Initial cervical dilation and the association of the success of atosiban. Int J Pregn & Chi Birth. 2019;5(2):103-6.

Baev OR, Vasil’chenko O, Karapetyan AO, Tetruashvili NK, Khodzhaeva ZS. A comparison of tocolysis with nifedipine or Atosiban in preterm. Akusherstvo i Ginekologiya. 2018;5:50-6.

Xu YJ, Ran LM, Luo XH, Zhai SS, Zhou ZY, Zhang YY, et al. Clinical efficacy of atosiban treatment in late abortion and preterm labour of twin pregnancy. Int J Clin Exp Med. 2016;9(2):3946-52.

Van Vliet EO, Nijman TA, Schuit E, Heida KY, Opmeer BC, Kok M, et al. Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial. The Lancet. 2016;387(10033):2117-24.

Saleh SS, Al-Ramahi MQ, Al Kazaleh FA. Atosiban and nifedipine in the suppression of pre-term labour: a comparative study. J Obst Gynaecol. 2013;33(1):43-5.

Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipin for the treatment of preterm labour. Int J Gynaecol Obstet. 2005;91(1):10-14.

French/Australian Atosiban investigators group. Treatment of preterm labour with the oxytocin antagonist atosiban: a double-blind, randomized, controlled comparison with salbutamol. European J Obs Gynecol Reprod Bio. 2001;98(2):177-85.

versus Beta-agonists TW. Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. Brit J Obst Gynaecol. 2001;108(2):133-42.

Moutquin JM, Sherman D, Cohen H. Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labour: a multicenter effectiveness and safety study. Am J Obstet Gynecol. 2000;182(5):1191-9.

Romero R, Sibai BM, Sanchez-Ramos L, Valenzuela GJ, Veille JC, Tabor B, et al. An oxytocin receptor antagonist (atosiban) in the treatment of preterm labour: a randomized, double-blind, placebo-controlled trial with tocolytic rescue. Am J Obst Gynecol. 2000;182(5):1173-83.

Schleußner E. The prevention, diagnosis and treatment of premature labour. Dtsch Arztebl Int. 2013;110(13):227-35.

López Gómez L. Oxytocin receptor antagonist (Atosiban) in the threat of preterm birth: does it have any effect on breastfeeding in the term newborn? Breastfeed Med. 2018;13(2):123-8.

Wex J, Connolly M, Rath W. Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation. BMC Pregnancy Childbirth. 2009;9:23.

Vrachnis N, Malamas FM, Sifakis S, Deligeoroglou E, Iliodromiti Z. The oxytocin‐oxytocin receptor system and its antagonists as tocolytic agents. Int J Endocrinol. 2011;1:350546.

Pavlidis I, Stock SJ. Preterm birth therapies to target inflammation. J Clin Pharmacol. 2022;62:79-93.