Atosiban Versus Placebo in the Treatment of Late Threatened Pre-term Birth

Preterm Birth Clinical Trial

— APOSTEL 8  

Official title:

Atosiban Versus Placebo in the Treatment of Late Threatened Preterm Birth

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05693688
• Other study ID #: NL80-84800-98-41027
• Status: Recruiting
• Phase: Phase 4
• Start date: December 1, 2017
• Est. completion date: July 2024

Study information

• Verified date: January 2023
• Source: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
• Contact: Larissa van der Windt, MD
• Phone: +31 6 42939524
• Email: apostel8[@]amsterdamumc.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this study is to investigate if tocolysis with atosiban in late preterm birth (30 to 34 weeks) is (cost-) effective compared with placebo in improving neonatal morbidity and mortality.

Description:

Research question Does tocolysis with atosiban reduce neonatal mortality and mortality in women with threatened preterm birth between 30 and 34 weeks when compared to placebo?

Study design Multicenter, double blinded, placebo controlled RCT

Study population Women with threatened preterm birth between 30 and 34 weeks of gestation are eligible for the trial. More than 20 hospitals (including all 10 perinatal centres) in the Netherlands will participate in this trial, as well as 15 hospitals in the UK and 1 in Dublin, Ireland.

Threatened preterm birth is defined as listed below in the inclusion criteria. Our previous APOSTEL III study showed that half of the women with these criteria deliver within seven days, validating this definition of women at high risk for preterm birth.

Inclusion criteria

• Women ≥ 18 years old

• Singleton or twin pregnancy

• Gestational age between 30 0/7 and 33 6/7 weeks

• Threatened preterm birth defined by regular uterine contractions, AND one of the following:

• Cervical length of < 15 mm OR

• Cervical length of 15-30 mm and a positive Fibronectine test (≥ 50 ng/mL) OR

• In case of absence of cervical length measurement in local protocol a positive Fibronectin test or Partus test OR

• Ruptured amniotic membranes

Exclusion criteria

• Previous treatment for threatened preterm birth with corticosteroids.

• Contra-indication for tocolysis

• Signs of fetal distress

• Signs of intra uterine infection

Participants RCT: 760 (380 per group)

Description of intervention(s) Tocolysis with atosiban versus placebo.

Outcome measures The primary outcome is a combined perinatal outcome of severe neonatal morbidity and perinatal mortality Secondary outcomes will be birth within 48 hours, time to delivery, gestational age at delivery, birth weight, number of days on invasive mechanical ventilation, length of admission in NICU, convulsions, asphyxia, meningitis, pneumothorax and mortality until 3 months corrected age, maternal infection, maternal side effects and costs.

All outcomes are in the electronic patient file. No additional tests are required for mother or baby.

Power / data analysis Based on the APOSTEL 3 data, the proportion of adverse perinatal outcome in women randomized between 30 and 34 weeks gestation and treated with atosiban was 6%. Based on two recent studies, we expect a 49,8% reduction of 11,95% adverse perinatal outcome in the placebo group to 6% in the atosiban group. Therefore we need to randomize 722 women (beta-error 0.2; alpha error 0.05). Assuming a 5% drop-out rate, we need to randomize 760 women (380 in each arm).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 760
• Est. completion date: July 2024
• Est. primary completion date: July 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Women = 18 years

• Singleton or twin pregnancy

• Gestational age between 30 0/7 and 33 6/7 weeks

• Threatened preterm birth defined by regular uterine contractions, AND one of the following:

• Cervical length of < 15 mm OR

• Cervical length of 15-30 mm and a positive Fibronectine test (= 50 ng/mL) OR

• In case of absence of cervical length measurement in local protocol a positive Fibronectin test or Partus test OR

• Ruptured amniotic membranes

Exclusion Criteria:

• Previous treatment for threatened preterm birth with corticosteroids in current pregnancy

• Contra indication for tocolysis

• Signs of fetal distress

• Signs of intra uterine infection

Related Conditions & MeSH terms

• Premature Birth
• Preterm Birth

Intervention

Drug:
• Atosiban
atosiban i.v. administred for 48 hours. The medication will be administered by a bolus injection of 6.75 mg/0.9 mL in 1 min followed by a continuous infusion of 18 mg/hour for 3 hours followed by a continuous infusion of 6 mg/hour for the remaining 45 hours.

Locations

Country	Name	City	State
Netherlands	Amsterdam University Medical Centres, location AMC	Amsterdam	Noord-Holland

Sponsors (30)

Lead Sponsor

Collaborator

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Amphia Hospital, Deventer Ziekenhuis, Diakonessenhuis, Utrecht, Erasmus Medical Center, Flevoziekenhuis, Franciscus Gasthuis, Gelre Hospitals, Groene Hart Ziekenhuis, Haaglanden Medical Centre, Isala, Leiden University Medical Center, Maastricht University Medical Center, Martini Hospital Groningen, Maxima Medical Center, Medical Centre Leeuwarden, Medisch Spectrum Twente, National Maternity Hospital, Ireland, Nottingham University Hospitals NHS Trust, OLVG, Radboud University Medical Center, Rijnstate Hospital, Spaarne Gasthuis, ST. Antonius hospital Nieuwegein, Tergooi Hospital, UMC Utrecht, University Medical Center Groningen, Ziekenhuisgroep Twente, ZonMw: The Netherlands Organisation for Health Research and Development, Zuyderland Medical Centre

Country where clinical trial is conducted

Netherlands, 

References & Publications (1)

Klumper J, Breebaart W, Roos C, Naaktgeboren CA, van der Post J, Bosmans J, van Kaam A, Schuit E, Mol BW, Baalman J, McAuliffe F, Thornton J, Kok M, Oudijk MA. Study protocol for a randomised trial for atosiban versus placebo in threatened preterm birth: the APOSTEL 8 study. BMJ Open. 2019 Nov 26;9(11):e029101. doi: 10.1136/bmjopen-2019-029101. Erratum In: BMJ Open. 2022 Oct 21;12(10):e029101corr1. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Costs		Up to 3 months corrected age
Primary	Adverse neonatal outcome	Combination perinatal mortality and severe neonatal morbidity (BPD, NEC, ROP, IVH, PVL, sepsis,	Up to 3 months corrected age
Secondary	Birth within 48 hours		48 hours
Secondary	Time to delivery		Not applicible
Secondary	Gestational age at delivery		At birth
Secondary	Birth weight		At birth
Secondary	Mechanical ventilation	Number of days on invasive ventilation	Up to 3 months corrected age
Secondary	NICU	Lengt of admission in NICU	Up to 3 months corrected age
Secondary	Convulsions		Up to 3 months corrected age
Secondary	Asphyxia		Up to 3 months corrected age
Secondary	Meningitis		Up to 3 months corrected age
Secondary	Pneumothorax		Up to 3 months corrected age
Secondary	Maternal infection		Up to 3 months corrected age
Secondary	Maternal side effects		Up to 3 months corrected age

External Links

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