Am J Perinatol 2018; 35(12): 1228-1234
DOI: 10.1055/s-0038-1642062
Commentary
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PROLONG Clinical Study Protocol: Hydroxyprogesterone Caproate to Reduce Recurrent Preterm Birth

Sean C. Blackwell
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
,
Cynthia Gyamfi-Bannerman
2   Department of Obstetrics and Gynecology, Preterm Birth Prevention Center, Columbia University Medical Center, New York, New York
,
Joseph R. Biggio Jr
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Suneet P. Chauhan
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
,
Brenna L. Hughes
4   Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
,
Judette M. Louis
5   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Tracy Manuck
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Hugh S. Miller
7   Watching Over Mothers and Babies Foundation, Tucson, Arizona
8   Valley Perinatal Services, Tucson, Arizona
,
Anita F. Das
9   Das Consulting, San Francisco, California
,
Robert Birch
10   AMAG Pharmaceuticals, Inc, Waltham, Massachusetts
,
Michael J. Jozwiakowski
11   Department of Research and Development, AMAG Pharmaceuticals, Inc., Waltham, Massachusetts
› Author Affiliations
Funding The PROLONG study is being funded by AMAG Pharmaceuticals.
Further Information

Publication History

20 March 2018

20 March 2018

Publication Date:
27 April 2018 (online)

Abstract

The objective of this commentary is to describe the background, rationale, and methods of the PROLONG (Progestin's Role in Optimizing Neonatal Gestation) trial, which is a multicenter, multinational, placebo-controlled, randomized clinical trial (RCT) designed to assess the safety and efficacy of Makena (hydroxyprogesterone caproate injection, 250 mg/mL) in reducing the risk of preterm birth (PTB) and neonatal morbidity/mortality in women pregnant with a singleton gestation who had a previous singleton spontaneous PTB. The total sample size of the RCT will include 1,707 women. The trial has two coprimary outcomes: PTB less than 35 weeks and a composite neonatal morbidity and mortality index. This study sample size will provide 90% power to assess for a 35% reduction in neonatal morbidity and mortality. Secondary outcomes will include 2-year follow-up of infants. The trial is ongoing and targeted to complete recruitment in 2018.

 
  • References

  • 1 Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet 2008; 371 (9607): 164-175
  • 2 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
  • 3 Keirse MJ. Progestogen administration in pregnancy may prevent preterm delivery. Br J Obstet Gynaecol 1990; 97 (02) 149-154
  • 4 Meis PJ, Klebanoff M, Thom E. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348 (24) 2379-2385
  • 5 Makena (hydroxyprogesterone caproate injection) [package insert]. Waltham, MA: AMAG Pharmaceuticals; revised April 2016
  • 6 Schardein JL, Birch R, Hesley R, Thorsrud BA. Multigeneration reproductive study of hydroxyprogesterone caproate (HPC) in the rat: laboratory results and clinical significance. Birth Defects Res B Dev Reprod Toxicol 2012; 95 (02) 160-174
  • 7 Pharmacokinetic study of Makena ® (hydroxyprogesterone caproate injection, 250 mg/mL) and its metabolites in blood. Available at: https://clinicaltrials.gov/ct2/show/NCT01899846 . Last updated August 18, 2014. Accessed October 30, 2017
  • 8 Confirmatory study of 17P versus vehicle for the prevention of preterm birth in women with a previous spontaneous preterm delivery (PROLONG). Available at: https://clinicaltrials.gov/ct2/show/NCT01004029 . Last updated March 8, 2017. Accessed October 30, 2017
  • 9 A prospective, noninterventional follow-up study of children aged 23 to 25 months, born to mothers who received hydroxyprogesterone caproate injection, 250 mg/mL, or vehicle for prevention of preterm birth. Available at: https://clinicaltrials.gov/ct2/show/NCT01146990 . Last updated December 11, 2015. Accessed October 30, 2017
  • 10 Northen AT, Norman GS, Anderson K. , et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Follow-up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo. Obstet Gynecol 2007; 110 (04) 865-872
  • 11 ASQ Version 3 Users Guide. Baltimore, MD: Brookes Publishing; 2009
  • 12 Bayley N. Bayley Scales of Infant and Toddler Development, 3rd ed. San Antonio, TX: Pearson Inc; 2006
  • 13 Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella. Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol 2012; 206 (05) 376-386
  • 14 Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol 2012; 120 (04) 964-973
  • 15 Gyamfi-Bannerman C, Thom EA. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 375 (05) 486-487
  • 16 Shankaran S, Laptook AR, Pappas A. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Effect of depth and duration of cooling on death and disability at age 18 months among neonates with hypoxic-ischemic encephalopathy: a randomized clinical trial. JAMA 2017; 318 (01) 57-67
  • 17 Manja V, Saugstad OD, Lakshminrusimha S. Oxygen saturation targets in preterm infants and outcomes at 18–24 months: a systematic review. Pediatrics 2017; 139 (01) e20161609
  • 18 Petrini JR, Callaghan WM, Klebanoff M. , et al. Estimated effect of 17 alpha-hydroxyprogesterone caproate on preterm birth in the United States. Obstet Gynecol 2005; 105 (02) 267-272