Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

Abstract

Objective To compare the effectiveness and safety of dexamethasone versus betamethasone for preterm birth (registered in PROSPERO CRD42017078006). Search strategy We searched in MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform, reference lists and contacted field experts. Selection criteria, data collection and analysis Randomized controlled trials comparing any corticosteroids against each other or against placebo. Three researchers independently selected, extracted data and assessed the risk of bias of the included studies by using EROS and COVIDENCE software. We performed a pairwise meta-analysis and Bayesian network meta-analysis. Main results We included 45 trials (11227 women, 11878 infants). There was no important difference between corticosteroids in neonatal death (odds ratio[OR] 1.05; 95% confidence interval 0.62-1.84; moderate-certainty evidence[CE]), neurodevelopmental disability (OR 1.03; 0.80-1.33; moderate-CE), intraventricular haemorrhage (OR 1.04; 0.56-1.78); low-CE) and birthweight (+5.29 gr;-49.79 to 58.97; high-CE). Compared with betamethasone, dexamethasone may reduce chorioamnionitis (OR 0.70; 0.45-1.06; moderate-CE), foetal death (OR 0.81; 0.24-2.41; low-CE) while may increase puerperal sepsis (OR 2.04; 0.72-6.06; low-CE) and respiratory distress syndrome (OR 1.34; 0.96-2.11; moderate-CE), however, the confidence interval indicates both beneficial and detrimental effects. Conclusions We found no important difference on neonatal death, neurodevelopmental disability, intraventricular haemorrhage and birthweight between corticosteroids. Compared with betamethasone, dexamethasone may reduce chorioamnionitis and foetal death, but may increase endometritis/puerperal sepsis and respiratory distress syndrome. Further research is warranted to improve the certainty of evidence.

Preventing Brain Injury in the Preterm Infant—Current Controversies and Potential Therapies

“…Importantly, a recent randomized double-blind controlled trial including 1509 fetuses who received antenatal corticosteroids, showed no significant difference in neurosensory disability at 2 years of age between those treated with dexamethasone and those treated with betamethasone [ 54 ]. Consistent with this, a recent meta-analysis of 45 trials including 11,227 women and 11,878 infants, found no difference between dexamethasone and betamethasone on neonatal death, neurodevelopmental disability, IVH and birthweight [ 55 ]. In contrast to the consistent short-term benefits seen in clinical trials, preclinical studies from a wide range of animal models have raised concerns that antenatal steroids may have adverse effects on neurological outcomes.…”

A Comparative Study of the Respiratory Neonatal Outcomes Utilizing Dexamethasone Sodium Phosphate versus a Mixture of Betamethasone Dipropionate and Betamethasone Sodium Phosphate as an Antenatal Corticosteroid Therapy

“…However, it can decrease the development of chorioamnionitis and fetal death. 32 These findings could be attributed to the pharmacokinetic properties of each formulation. A 1:1 mixture of betamethasone phosphate and betamethasone acetate has a fast and sustained release in which its plasma levels could be detected after 14 days of a single intramuscular injection.…”

Administration of Antenatal Corticosteroids: Current State of Knowledge

“…Auch die letzte Metaanalyse zu diesem Thema, in die die Daten aus 45 Studien von 11 227 Frauen und 11 878 Kindern einflossen, konnte keine Unterschiede hinsichtlich der perinatalen und maternalen Morbidität zwischen Dexamethason und Betamethason nachweisen. Die Inzidenz der Sectio caesarea wurde in dieser Metaanalyse nicht näher untersucht 15 .…”

“…The most recent meta-analysis on this topic, which included data from 45 studies covering 11 227 women and 11 878 children, found no differences with regard to perinatal and maternal morbidity rates between dexamethasone and betamethasone. The meta-analysis did not investigate the incidence of cesarean section 15 .…”