{"title":"米非司酮和米索前列醇与单用米索前列醇治疗流产和宫内胎死的疗效和安全性比较:系统综述与元分析》。","authors":"Rachael G Pirrami, Justin P Reinert","doi":"10.1177/10600280241289968","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the efficacy and safety of mifepristone and misoprostol together (intervention) compared to misoprostol alone (comparator) for the resolution of miscarriage and intrauterine fetal death.</p><p><strong>Data sources: </strong>A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology through July 2024 that evaluated the efficacy and safety of mifepristone and misoprostol together compared to misoprostol alone for the resolution of miscarriage and intrauterine fetal death through July 2024.</p><p><strong>Study selection and data extraction: </strong>Primary endpoints were overall delivery success, 24-hour delivery success, and incidence of safety outcomes. A <i>P</i>-value of <0.05 was considered statistically significant, and heterogeneity was reported as the I<sup>2</sup> value.</p><p><strong>Data synthesis: </strong>Twelve randomized controlled trials (RCTs) were included. Overall delivery success was higher in the intervention group (0.73 [CI 0.64-0.82], <i>P</i> < 0.01). Twenty-four-hour delivery rate was higher (1.54 [CI 1.32-1.77], <i>P</i> = 0.06), and a shorter time to delivery interval (9.22-18.78 vs 15.47-37.1 hours) was observed in the intervention group. Gastrointestinal adverse effects were more frequent in the intervention group (0.04 [CI -0.03 to 0.12], <i>P</i> < 0.01).</p><p><strong>Relevance to patient care and clinical practice: </strong>Mifepristone and misoprostol together demonstrated higher delivery success rates and comparable safety outcomes to misoprostol alone, demonstrating the potential of improving patient care and positively impacting the time to successful delivery for patients at the bedside.</p><p><strong>Conclusions: </strong>The use of mifepristone and misoprostol together for the resolution of miscarriage and intrauterine fetal death is warranted over the use of misoprostol alone.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280241289968"},"PeriodicalIF":2.3000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Mifepristone and Misoprostol Compared to Misoprostol Alone for the Resolution of Miscarriage and Intrauterine Fetal Death: A Systematic Review and Meta-Analysis.\",\"authors\":\"Rachael G Pirrami, Justin P Reinert\",\"doi\":\"10.1177/10600280241289968\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the efficacy and safety of mifepristone and misoprostol together (intervention) compared to misoprostol alone (comparator) for the resolution of miscarriage and intrauterine fetal death.</p><p><strong>Data sources: </strong>A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology through July 2024 that evaluated the efficacy and safety of mifepristone and misoprostol together compared to misoprostol alone for the resolution of miscarriage and intrauterine fetal death through July 2024.</p><p><strong>Study selection and data extraction: </strong>Primary endpoints were overall delivery success, 24-hour delivery success, and incidence of safety outcomes. A <i>P</i>-value of <0.05 was considered statistically significant, and heterogeneity was reported as the I<sup>2</sup> value.</p><p><strong>Data synthesis: </strong>Twelve randomized controlled trials (RCTs) were included. Overall delivery success was higher in the intervention group (0.73 [CI 0.64-0.82], <i>P</i> < 0.01). Twenty-four-hour delivery rate was higher (1.54 [CI 1.32-1.77], <i>P</i> = 0.06), and a shorter time to delivery interval (9.22-18.78 vs 15.47-37.1 hours) was observed in the intervention group. Gastrointestinal adverse effects were more frequent in the intervention group (0.04 [CI -0.03 to 0.12], <i>P</i> < 0.01).</p><p><strong>Relevance to patient care and clinical practice: </strong>Mifepristone and misoprostol together demonstrated higher delivery success rates and comparable safety outcomes to misoprostol alone, demonstrating the potential of improving patient care and positively impacting the time to successful delivery for patients at the bedside.</p><p><strong>Conclusions: </strong>The use of mifepristone and misoprostol together for the resolution of miscarriage and intrauterine fetal death is warranted over the use of misoprostol alone.</p>\",\"PeriodicalId\":7933,\"journal\":{\"name\":\"Annals of Pharmacotherapy\",\"volume\":\" \",\"pages\":\"10600280241289968\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-10-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Pharmacotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10600280241289968\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10600280241289968","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
目的确定米非司酮和米索前列醇合用(干预)与米索前列醇单用(比较)在解决流产和宫内胎儿死亡方面的有效性和安全性:根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic reviews and Meta-Analyses,PRISMA)方法进行了系统综述和荟萃分析,评估了米非司酮和米索前列醇合用与单用米索前列醇相比,在解决流产和宫内胎儿死亡方面的有效性和安全性:主要终点为总体分娩成功率、24小时分娩成功率和安全结果发生率。数据综合:纳入了 12 项随机对照试验(RCT)。干预组的总体分娩成功率更高(0.73 [CI 0.64-0.82],P < 0.01)。干预组的 24 小时分娩率更高(1.54 [CI 1.32-1.77],P = 0.06),分娩间隔时间更短(9.22-18.78 小时 vs 15.47-37.1 小时)。干预组的胃肠道不良反应发生率更高(0.04 [CI -0.03 to 0.12],P < 0.01):米非司酮和米索前列醇合用与单独使用米索前列醇相比,分娩成功率更高,安全性相当,显示出改善患者护理的潜力,并对床边患者成功分娩的时间产生积极影响:结论:米非司酮和米索前列醇联合用于解决流产和宫内胎儿死亡问题比单独使用米索前列醇更有必要。
Efficacy and Safety of Mifepristone and Misoprostol Compared to Misoprostol Alone for the Resolution of Miscarriage and Intrauterine Fetal Death: A Systematic Review and Meta-Analysis.
Objective: To determine the efficacy and safety of mifepristone and misoprostol together (intervention) compared to misoprostol alone (comparator) for the resolution of miscarriage and intrauterine fetal death.
Data sources: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology through July 2024 that evaluated the efficacy and safety of mifepristone and misoprostol together compared to misoprostol alone for the resolution of miscarriage and intrauterine fetal death through July 2024.
Study selection and data extraction: Primary endpoints were overall delivery success, 24-hour delivery success, and incidence of safety outcomes. A P-value of <0.05 was considered statistically significant, and heterogeneity was reported as the I2 value.
Data synthesis: Twelve randomized controlled trials (RCTs) were included. Overall delivery success was higher in the intervention group (0.73 [CI 0.64-0.82], P < 0.01). Twenty-four-hour delivery rate was higher (1.54 [CI 1.32-1.77], P = 0.06), and a shorter time to delivery interval (9.22-18.78 vs 15.47-37.1 hours) was observed in the intervention group. Gastrointestinal adverse effects were more frequent in the intervention group (0.04 [CI -0.03 to 0.12], P < 0.01).
Relevance to patient care and clinical practice: Mifepristone and misoprostol together demonstrated higher delivery success rates and comparable safety outcomes to misoprostol alone, demonstrating the potential of improving patient care and positively impacting the time to successful delivery for patients at the bedside.
Conclusions: The use of mifepristone and misoprostol together for the resolution of miscarriage and intrauterine fetal death is warranted over the use of misoprostol alone.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days