Efficacy of Dydrogesterone in Threatened Miscarriage: a Systematic Review and Meta-analysis

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 statisticallysignificantly 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. Keywords: miscarriage, recurrent pregnancy loss, habitual miscarriage, progestagens, dydrogesterone, progesterone.