Objective: Treatment of congenital adrenal hyperplasia (CAH) patients with glucocorticoids is often challenging since there is a delicate balance between over- and undertreatment. Treatment can be monitored non-invasively by measuring salivary androstenedione (A4) and 17-hydroxyprogesterone (17-OHP). Optimal treatment monitoring requires establishment of reference values in saliva.
Design: Descriptive study PATIENTS: For this study saliva of 255 healthy paediatric and adult volunteers with an age range of 4-75 years old was used.
Measurements: We developed a sensitive LC-MS/MS method, assessed salivary A4 and 17-OHP stability and measured A4 and 17-OHP concentrations in saliva collected in the morning, afternoon and evening.
Results: We quantified A4 and 17-OHP concentrations in the morning, afternoon, and evening and demonstrated that there is a significant rhythm with highest levels in the morning and decreasing levels over the day. A4 and 17-OHP concentrations display an age-dependent pattern. These steroids remain stable in saliva at ambient temperature for up to five days.
Conclusions: Good stability of the steroids in saliva enables saliva collection by the patient at home. Since salivary A4 and 17-OHP display a diurnal rhythm and age-dependent pattern, we established reference values for both children and adults at three time points during the day. These reference values support treatment monitoring of children and adults with CAH. This article is protected by copyright. All rights reserved.
The efficiency of 17a hydroxyprogesterone in the prevention of preterm labour irrespective of administration route: Systematic review metanalysis
Objective: To verify the benefits of 17 alpha hydroxyprogesterone use throughout the second half of pregnancy in preventing preterm birth among those with an increased risk of preterm birth.
Methods: The systematic review was conducted at the University Hospital, Baghdad, Iraq, from June 2020 to July 2021, and comprised search for randomised controlled trials having used progesterone for the prevention of preterm birth among women with a short cervix length <2.5cm. The search, conducted on Cochrane, Medline, PubMed and Scopus databases, was not limited by publication date. Cochrane guideline for conducting systematic review and metanalysis was used.
Results: There were 3 randomised controlled trials comprising 1705 subjects; 860(50.4%) cases and 845(49.6%) controls in the placebo group. Among them, 175(20.3%) cases and 197(23.3%) controls suffered from preterm labour (p=0.116).
Conclusions: Though earlier evidence supported the benefits of locally applied progesterone to a short cervix in pregnancy prolongation, but the current analysis found no significant benefits in this regard.
17-Alpha-Hydroxyprogesterone vs. Placebo for Preventing of Recurrent Preterm Birth: A Systematic Review and Meta-Analysis of Randomized Trials
Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. Objective: To estimate the effect of 17-alpha-hydroxyprogesterone caproate (17-OHPC) compared to placebo in singleton gestations for reducing the risk of recurrent PTB and neonatal morbidity and mortality. Work Design: Systematic review and meta-analysis. Search Strategy: Searching MEDLINE, Embase, Web of Science, SCOPUS, Cochrane Library, and clinical trial registries. Selection Criteria: Randomized controlled trials of singleton gestations with a history of PTB and treated with a weekly intramuscular injection of 17-OHPC or placebo. Data Collection and Analysis: A random meta-analysis model was performed for the PTB outcomes (<32, <35, and <37 weeks) and neonatal outcomes (neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis). Effect estimates were measured by relative risk ratio (RR) with a 95% confidence interval (CI). Main Results: Six works were included. There were no statistically significant reductions in the PTB risk following the use of 17-OHPC at <32 weeks (RR = 0.61, 95% CI: 0.13-2.77, and I 2 = 39%), <35weeks (RR = 0.60, 95% CI: 0.10-3.67, and I 2 = 51%), and <37 weeks (RR = 0.68, 95% CI: 0.46-1, and I 2 = 75%). Furthermore, all the neonatal outcomes were statistically similar between the two groups. Conclusion: Treatment with 17-OHPC is not associated with reducing the risk of PTB or neonatal outcomes compared to placebo.
A 4-hour Profile of 17-hydroxyprogesterone in Salt-wasting Congenital Adrenal Hyperplasia: Is the Serial Monitoring Strategy Worth the Effort?
Objective: Since there exists no gold standard laboratory variable for adjustment of treatment in congenital adrenal hyperplasia (CAH), we aimed to assess the use of a 4-hour profile of serum 17-OHP to determine the most appropriate time and level of 17-OHP in predicting the metabolic control and evaluate the role of sex hormone-binding globulin (SHBG) in hyperandrogenemia.
Methods: This study included 16 children (9 girls,7 boys; median age 7 years) with salt-wasting CAH. Measurements for 17-OHP and cortisol were made from samples obtained before and 1,2,4 hours after the morning dose of hydrocortisone. Patients were designated to have poor metabolic control when androstenedione levels according to age and sex-specific reference intervals were high and annual height SDS changes were ⩾0.5.
Results: Premedication 17-OHP levels were strongly correlated with 17-OHP levels 1, 2, 4 hours after the morning dose (rs=0.929, p<0.01; rs=0.943, p<0.01; rs=0.835, p<0.01, respectively). 17-OHP profiles (0,1,2,4 hours) of poor (n=6) and good (n=10) metabolically controlled cases were similar. Among the patients with poor metabolic control, two cases had 17-OHP levels <2 ng/mL at all times. Remaining patients with poor metabolic control had 17-OHP levels above 104 ng/mL, 82 ng/mL, 14 ng/mL, and 4 ng/mL, for baseline and 1, 2, and 4 hours, respectively. Differences between the poor and well-controlled group were androstenedione levels with respect to upper limit of normal [1.8(1.5) and 0.5(1.5) ng/mL, respectively p=0.03], annual change in height SDS [0.7(0.2) and -0.03(0.8) SDS, respectively, p=0.001], and daily hydrocortisone doses [7 (6) and 16 (8) mg/m2/day, respectively, p=0.02]. Androstenedione and SHBG levels were negatively correlated in the pubertal children (rs=-0.7, p=0.04).
Conclusion: We conclude that (i)a 4-hour 17-OHP profile is not useful in predicting hyperandrogenemia, (ii)suppressed levels of 17-OHP do not always indicate overtreatment, (iii)reference intervals of 17-OHP for different time periods might be of importance, (iv) low hydrocortisone doses should be avoided, (v)SHBG could be used in pubertal children as an indicator of hyperandrogenemia.
Hydroxyprogesterone |
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| MBS577853-100mg | MyBiosource | 100mg | 145 EUR |
Hydroxyprogesterone |
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| MBS577853-200mg | MyBiosource | 200mg | 155 EUR |
Hydroxyprogesterone |
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| MBS577853-25mg | MyBiosource | 25mg | 130 EUR |
Hydroxyprogesterone |
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| MBS577853-50mg | MyBiosource | 50mg | 140 EUR |
Hydroxyprogesterone |
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| MBS577853-5x200mg | MyBiosource | 5x200mg | 550 EUR |
Hydroxyprogesterone |
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| MBS3605635-100mg | MyBiosource | 100mg | 215 EUR |
Hydroxyprogesterone |
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| MBS3605635-200mg | MyBiosource | 200mg | 225 EUR |
Hydroxyprogesterone |
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| MBS3605635-25mg | MyBiosource | 25mg | 200 EUR |
Hydroxyprogesterone |
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| MBS3605635-50mg | MyBiosource | 50mg | 210 EUR |
Hydroxyprogesterone |
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| MBS3605635-5x200mg | MyBiosource | 5x200mg | 705 EUR |
17-Hydroxyprogesterone |
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| B6126-100 | ApexBio | 100 mg | 160.8 EUR |
17-Hydroxyprogesterone |
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| B6126-200 | ApexBio | 200mg | 72 EUR |
17-Hydroxyprogesterone |
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| B6126-5.1 | ApexBio | 10 mM (in 1mL DMSO) | 180 EUR |
17-Hydroxyprogesterone |
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| B6126-50 | ApexBio | 50mg | 27 EUR |
18-Hydroxyprogesterone |
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| H950660 | Toronto Research Chemicals | 10mg | 1401 EUR |
17-Hydroxyprogesterone |
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| MBS384032-100mg | MyBiosource | 100mg | 135 EUR |
17-Hydroxyprogesterone |
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| MBS384032-250mg | MyBiosource | 250mg | 170 EUR |
17-Hydroxyprogesterone |
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| MBS384032-5x250mg | MyBiosource | 5x250mg | 760 EUR |
17α-Hydroxyprogesterone |
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| T1429-10mg | TargetMol Chemicals | 10mg | Ask for price |
17α-Hydroxyprogesterone |
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| T1429-1g | TargetMol Chemicals | 1g | Ask for price |
17α-Hydroxyprogesterone |
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| T1429-1mg | TargetMol Chemicals | 1mg | Ask for price |
17α-Hydroxyprogesterone |
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| T1429-50mg | TargetMol Chemicals | 50mg | Ask for price |
17α-Hydroxyprogesterone |
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| T1429-5mg | TargetMol Chemicals | 5mg | Ask for price |
17α-Hydroxyprogesterone |
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| HY-B0891 | MedChemExpress | 1 g | 75.76 EUR |
17alpha Hydroxyprogesterone |
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| MBS340007-10mg | MyBiosource | 10mg | 3105 EUR |
17alpha Hydroxyprogesterone |
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| MBS340007-1mg | MyBiosource | 1mg | 800 EUR |
17alpha Hydroxyprogesterone |
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| MBS340007-5x10mg | MyBiosource | 5x10mg | 13805 EUR |
17alpha Hydroxyprogesterone |
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| MBS340728-10mg | MyBiosource | 10mg | 4030 EUR |
Eligibility, Utilization, and Effectiveness of 17-Alpha Hydroxyprogesterone Caproate (17OHPC) in a Statewide Population-Based Cohort of Medicaid Enrollees
Objectives: The primary objective was to estimate the initiation and adherence rates of 17 α-hydroxyprogesterone caproate (17OHPC) among eligible mothers in a statewide population-based cohort of Medicaid enrollees. The secondary objectives were to (1) determine the association of maternal sociodemographic and clinical characteristics with 17OHPC utilization and (2) assess the real-world effectiveness of 17OHPC on recurrent preterm birth prevention and admission to neonatal intensive care unit (NICU).
Study design: This is a retrospective cohort study using a linked, longitudinal administrative dataset of birth certificates and medical assistance claims. Medicaid-enrolled mothers in Pennsylvania were included in this study if they had at least one singleton live birth from 2014 to 2016 following at least one spontaneous preterm birth. Maternal Medicaid claims were used to ascertain the use of 17OHPC from various manufacturers, including compounded formulations. Propensity score matching was used to create a covariate balance between 17OHPC treatment and comparison groups.
Results: We identified 4,781 Medicaid-covered 17OHPC-eligible pregnancies from 2014 to 2016 in Pennsylvania, 3.4% of all Medicaid-covered singleton live births. The population-based initiation rate was 28.5% among eligible pregnancies. Among initiators, 50% received ≥16 doses as recommended, while 10% received a single dose only. The severity of previous spontaneous preterm birth was the strongest predictor for the initiation and adherence of 17OHPC. In the matched treatment (n = 1,210) and comparison groups (n = 1,210), we found no evidence of 17OHPC effectiveness. The risks of recurrent preterm birth (relative risk [RR] 1.10, 95% confidence interval [CI] 0.97-1.24) and births admitted to NICU (RR 1.00, 95% CI 0.84-1.18) were similar in treated and comparison mothers.
Conclusion: The 17OHPC-eligible population represented 3.4% of singleton live births. Less than one-third of eligible mothers initiated treatment. Among initiators, 50% were treatment adherent. We found no difference in the risk of recurrent preterm birth or admission to NICU between treatment and comparison groups.