Comparative Evaluation of Efficacy of Ritodrine Versus Nifedipine in Prevention of Preterm Labour in Direct Head to Head Randomized Control Trials: A Systematic Review

Abstract

Aims and Objectives: To compare the efficacy of ritodrine versus nifedipine in prevention of preterm labour at day two and seven. Methodology: All randomised control trials which follows PRISMA guidelines 2009 and in which Ritodrine and Nifedipine was compared head to head for the treatment of Pre-term labour. Clinical trial registries,MEDLINE, SCOPUS, EMBASE database were searched for MeSH terms Ritodrine, Nifedipine, pre-term labour and having primary outcome as number of delivery at day 2 and 7. Observational studies, unpublished studies, RCTs not following PRISMA guidelines were excluded. Data was analyzed using RevMan 5.3 version® and Odd’s Ratio was calculated to determine the difference at day 2 and 7. Both fixed effect and Random effect model was utilized to calculate the difference. P value less than 0.05 was considered as statistically significant. The I2 will be used to measure the heterogeneity between studies and a value > 30.0 will be considered to reflect heterogeneity. Results: A total of 6 Head to head RCTs were included in the studies. At day 2, according to fixed effect model, statistically ritodrine was having more likelihood for delivery as compared to nifedipine(Odd’s ratio=1.492, CI=1.013-2.197, P=0.043) but according to random effect model the difference was not statistically significant(Odd’s ratio=1.468, CI=0.919-2.344, P=0.108). At day 7, according to fixed effect model, ritodrine was having more likelihood for delivery as compared to nifedipine(Odd’s ratio=1.196, CI=0.852-1.679, P=0.302) and according to random effect model the difference was not statistically significant(Odd’s ratio=1.143, CI=0.720-1.815, P=0.572). Conclusion: Ritodrine causes more deliveries at day 2 and 7, so nifedipine is a better tocolytic as compared to ritodrine.