docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2022-21-5-53-61docru-284Research ArticleАКУШЕРСТВО И ПЕРИНАТОЛОГИЯOBSTETRICS AND PERINATOLOGYЭффективность дидрогестерона при угрожающем выкидыше: систематический обзор и метаанализEfficacy of Dydrogesterone in Threatened Miscarriage: a Systematic Review and Meta-analysishttps://orcid.org/0000-0002-9201-2281ТетруашвилиН. К.TetruashviliN. K.

Тетруашвили Нана Картлосовна — д. м. н., доцент, заместитель директора Института акушерства по научной работе, заведующая отделом медицины плода и 2-м акушерским отделением патологии беременности

117997, г. Москва, ул. Академика Опарина, д. 4

4 Academician Oparin Str., Moscow, 117997

tetrauly@mail.ruhttps://orcid.org/0000-0001-6589-7654ШихЕ. В.ShihE. V.

Ших Евгения Валерьевна — д. м. н., профессор, директор Института профессионального образования, заведующая кафедрой клинической фармакологии и пропедевтики внутренних болезней

119991, г. Москва, ул. Трубецкая, д. 8, стр. 2

8 Trubetskaya Str., build. 2, Moscow, 119991

shikh_e_v@staff.sechenov.ruФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Министерства здравоохранения Российской ФедерацииРоссияFSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov” Ministry of Healthcare of the Russian FederationRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation202219022025215ГИНЕКОЛОГИЯ5361Copyright © Тетруашвили Н.К., Ших Е.В., 20252025Тетруашвили Н.К., Ших Е.В.Tetruashvili N.K., Shih E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/284

Цель обзора: проанализировать все исследования с использованием дидрогестерона при угрожающем выкидыше (УВ) и оценить влияние лечения дидрогестероном на частоту выкидышей у женщин с УВ.Основные положения. Многолетний опыт в рамках множества клинических исследований подтверждает, что гестагены способствуют сохранению беременности в случае УВ. Дидрогестерон и прогестерон являются наиболее подходящими гестагенами для беременных женщин. Большой процент сохранения беременности высокого риска при использовании дидрогестерона обусловлен его химической структурой. Настоящий систематический обзор и метаанализ включает данные только рандомизированных исследований, в частности основанных на сравнении дидрогестерона с плацебо. Результаты демонстрируют, что в группе пациенток, получавших дидрогестерон, частота выкидышей была статистически значимо ниже, чем в группе женщин, получавших плацебо. Эти выводы коррелируют с предыдущими данными метаанализов и обзоров рандомизированных клинических исследований 2017–2021 гг., в которых дидрогестерон также значительно снижал риск потери беременности при угрожающем и привычном выкидыше. Более того, в крупнейшем прямом сравнительном рандомизированном исследовании IPD LOTUS (2020) продемонстрирована более высокая эффективность дидрогестерона, чем у микронизированного вагинального прогестерона.Заключение. По результатам настоящего систематического обзора и метаанализа рандомизированных клинических исследований, основанных на сравнении дидрогестерона с плацебо, у пациенток, получавших дидрогестерон, частота выкидышей была статистически значимо ниже, чем у женщин, получавших плацебо. Применение дидрогестерона не только оправданный, но крайне необходимый компонент терапии привычной потери беременности.

Objective of the Review: To review all studies using dydrogesterone in threatened miscarriage and to evaluate the effect of dydrogesterone treatment on miscarriage rates in women with miscarriage.Key points. Many years of experience in many clinical studies confirm that progestogens contribute to the preservation of pregnancy in the event of a threatened miscarriage. Dydrogesterone and progesterone are the most suitable progestogens for pregnant women. The high result of dydrogesterone in high-risk pregnancy is due to its chemical structure. This systematic review and meta-analysis includes data only from randomized trials, in particular those based on comparisons of dydrogesterone with placebo. The results demonstrate that in the group of patients treated with dydrogesterone, the frequency of miscarriages was statistically significantly lower than in the group of patients treated with placebo. These findings correlate with previous data from meta-analyses and reviews of randomized clinical trials in 2017–2021, where dydrogesterone also significantly reduced the risk of pregnancy loss in threatened and recurrent miscarriage. Moreover, the largest direct comparative randomized study IPD LOTUS (2020) demonstrated a higher efficacy of dydrogesterone compared to micronized vaginal progesterone.Conclusion. According to the results of this systematic review and meta-analysis of randomized clinical trials based on the comparison of dydrogesterone with placebo, in the group of patients who received dydrogesterone, the frequency of miscarriages was statistically significantly lower than in the group of patients who received placebo. The use of dydrogesterone is not only justified, but an essential component of the treatment of recurrent pregnancy loss.

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The authors declare that there are no conflicts of interest present.