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Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis
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  • Agustín Ciapponi,
  • Karen Klein,
  • Daniela Colaci,
  • Fernando Althabe,
  • J. M. Belizan,
  • Allie Deegan,
  • Areti Veroniki,
  • Iván Flórez
Agustín Ciapponi
1. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)
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Karen Klein
1. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)
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Daniela Colaci
1. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)
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Fernando Althabe
World Health Organization
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J. M. Belizan
1. Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)
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Allie Deegan
New York University College of Global Public Health
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Areti Veroniki
University of Ioannina
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Iván Flórez
McMaster University Faculty of Health Sciences, University of Antioquia
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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. Keywords preterm birth, antenatal corticosteroids, dexamethasone, betamethasone, systematic review, network meta-analysis