17-OHPC to Prevent Recurrent Preterm Birth in Singleton Gestations (PROLONG Study): A Multicenter, International, Randomized Double-Blind Trial
Creators: name: Baker, J.
name: Chauhan, S.P.
name: Das, A.F.
name: Saade, G.R.
name: Yuzko, O.M.
name: Gudeman, J.
name: Biggio, J.R.
name: Gyamfi-Bannerman, C.
name: Duncan, M.
name: Blackwell, S.C.
name: Pekarev, O.
name: Nielsen, P.
name: Krop, J.
name: Hughes, B.L.
name: Reznichenko, N.Y.
name: Williams, L.
name: Tatarova, N.
name: Miller, H.S.
name: Jozwiakowski, M.J.
name: Manuck, T.A.
name: Birch, R.
name: Reznichenko, G.I.
name: Louis, J.M.
Publisher: name: Thieme Medical Publishers, Inc.
Year: 2020

description: Background âwomen with a history of spontaneous preterm birth (SPTB) are at a significantly increased risk for recurrent preterm birth (PTB). To date, only one large U.S. clinical trial comparing 17-OHPC (17-α-hydroxyprogesterone caproate or 17P) to placebo has been published, and this trial was stopped early due to a large treatment benefit. Objective âThis study aimed to assess whether 17-OHPC decreases recurrent PTB and neonatal morbidity in women with a prior SPTB in a singleton gestation. Study Design âThis was a double-blind, placebo-controlled international trial involving women with a previous singleton SPTB (clinicaltrials.gov: NCT 01004029). Women were enrolled at 93 clinical centers (41 in the United States and 52 outside the United States) between 16 0/7 to 20 6/7 weeks in a 2:1 ratio, to receive either weekly intramuscular (IM) injections of 250 mg of 17-OHPC or an inert oil placebo; treatment was continued until delivery or 36 weeks. Co-primary outcomes were PTB &lt; 35 weeks and a neonatal morbidity composite index. The composite included any of the following: Neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, or proven sepsis. A planned sample size of 1,707 patients was estimated to provide 98% power to detect a 30% reduction in PTB &lt; 35 weeks (30% to 21%) and 90% power to detect a 35% reduction in neonatal composite index (17%-11%) using a two-sided type-I error of 5%. Finally, this sample size would also provide 82.8% power to rule out a doubling in the risk of fetal/early infant death assuming a 4% fetal/early infant death rate. Analysis was performed according to the intention-to-treat principle. Results âaseline characteristics between the 1,130 women who received 17-OHPC and 578 women who received placebo were similar. Overall, 87% of enrolled women were Caucasian, 12% had &gt;1 prior SPTB, 7% smoked cigarettes, and 89% were married/lived with partner. Prior to receiving study drug, 73% women had a transvaginal cervical length measurement performed and &lt;2% had cervical shortening &lt;25 mm. There were no significant differences in the frequency of PTB &lt; 35 weeks (17-OHPC 11.0% vs. placebo 11.5%; relative risk = 0.95 [95% confidence interval (CI): 0.71-1.26]) or neonatal morbidity index (17-OHPC 5.6% vs. placebo 5.0%; relative risk = 1.12 [95% CI: 0.68-1.61]). There were also no differences in frequency of fetal/early infant death (17-OHPC 1.7% vs. placebo 1.9%; relative risk = 0.87 [95% CI: 0.4-1.81]. Maternal outcomes were also similar. In the subgroup of women enrolled in the United States (n = 391; 23% of all patients), although the rate of PTB &lt; 35 weeks was higher than the overall study population, there were no statistically significant differences between groups (15.6% vs. 17.6%; relative risk = 0.88 [95% CI: 0.55, 1.40]. Conclusion âin this study population, 17-OHPC did not decrease recurrent PTB and was not associated with increased fetal/early infant death.