A systematic review of randomized controlled trials for the prevention of bronchopulmonary dysplasia in infants

• Published in: Journal of perinatology Vol. 34; no. 9; pp. 705 - 710
• Main Authors: Beam, K S, Aliaga, S, Ahlfeld, S K, Cohen-Wolkowiez, M, Smith, P B, Laughon, M M
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-09-2014; Nature Publishing Group
• Subjects: 692/699/1785; 692/700/1720/3186; 692/700/565/1436/1983; Analysis; Bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - drug therapy; Bronchopulmonary Dysplasia - prevention & control; Care and treatment; Clinical trials; Clinical Trials, Phase I as Topic; Collaboration; Diagnosis; Drug development; Drug dosages; Drugs; Dysplasia; Health aspects; Humans; Infant, Newborn; Infants; Infants (Premature); Libraries; Lung diseases; Medicine; Medicine & Public Health; Meta-analysis; Meta-Analysis as Topic; Morbidity; Mortality; Newborn babies; original-article; Pediatric Surgery; Pediatrics; Pharmacovigilance; Pilot projects; Premature babies; Premature birth; Prevention; Public health; Randomized Controlled Trials as Topic; Respiratory distress syndrome; Risk factors; Systematic review; United States > US
• ISSN: 0743-8346; 1476-5543; 1476-5543
• DOI: 10.1038/jp.2014.126

Objective:
Bronchopulmonary dysplasia (BPD) is the most common cause of pulmonary morbidity in premature infants and is associated with life-long morbidities. Developing drugs for the prevention of BPD would improve public health. We sought to determine characteristics of favorable randomized controlled trials (RCTs) of drugs for BPD prevention.
Study Design:
We searched MEDLINE and EMBASE from 1992 to 2014 using the MeSH terms ‘BPD’ and ‘respiratory distress syndrome, newborn’. We included a Cochrane Library search to ensure inclusion of all available RCTs. We identified RCTs with BPD as a primary or secondary outcome and determined the definition of BPD used by the study. We determined whether a phase I or phase II study—to determine drug safety, efficacy or optimal dose—was performed before the RCT. Finally, we searched the Cochrane Library for meta-analyses for each drug and used the results of available meta-analyses to define a favorable versus unfavorable RCT.
Result:
We identified 2026 articles; 47 RCTs met our inclusion criteria encompassing 21 drugs; 5 of the drugs reduced the incidence of BPD. We found data from phase I or II studies for 16 of the drugs, but only 1 demonstrated a reduction of BPD.
Conclusion:
The majority of the drugs studied in RCTs failed to reduce the incidence of BPD. Performing early-phase studies before phase III trials might provide necessary information on drugs and drug doses capable of preventing BPD, thus informing the development of future RCTs.