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Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus.

Publication ,  Journal Article
Gulack, BC; Laughon, MM; Clark, RH; Sankar, MN; Hornik, CP; Smith, PB
Published in: Early Hum Dev
December 2015

BACKGROUND: Patent ductus arteriosus (PDA) is common in extremely premature infants and associated with increased morbidity and mortality. Medical management of PDA uses either indomethacin or ibuprofen. Despite numerous studies, uncertainty exists as to which drug is safer or more effective; we sought to fill this knowledge gap. METHODS: We identified infants <28weeks gestational age discharged from neonatal intensive care units included in the Pediatrix Medical Group Clinical Data Warehouse between 2006 and 2012 who were treated with indomethacin or ibuprofen between postnatal days 2 and 14. Infants treated with both drugs or infants with a congenital malformation were excluded. We used multivariable logistic regression to determine the association of indomethacin versus ibuprofen on clinical outcomes. RESULTS: Of 6349 patients who met study criteria, 1177 (19%) received ibuprofen and 5172 (81%) received indomethacin. The median gestational age was 25weeks (interquartile range 24-26), and 2894 (46%) infants were <750g at birth. On unadjusted analysis, infants who received ibuprofen had significantly higher incidences of death prior to discharge, surgical ligation of the PDA prior to discharge, death or spontaneous intestinal perforation within 7days of therapy, death or surgical ligation of the PDA prior to discharge, and an elevated creatinine within 7days of treatment. However, on multivariable analysis, no significant differences in outcomes were observed (odds ratio for death/PDA ligation for ibuprofen vs. indomethacin=1.12 [95% CI 0.91-1.39]). CONCLUSIONS: We observed similar effectiveness and safety profiles for indomethacin and ibuprofen in the medical management of PDA in premature infants.

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Published In

Early Hum Dev

DOI

EISSN

1872-6232

Publication Date

December 2015

Volume

91

Issue

12

Start / End Page

725 / 729

Location

Ireland

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn
  • Infant, Extremely Premature
  • Infant
  • Indomethacin
  • Ibuprofen
  • Humans
 

Citation

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Gulack, B. C., Laughon, M. M., Clark, R. H., Sankar, M. N., Hornik, C. P., & Smith, P. B. (2015). Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus. Early Hum Dev, 91(12), 725–729. https://doi.org/10.1016/j.earlhumdev.2015.08.003
Gulack, Brian C., Matthew M. Laughon, Reese H. Clark, Meera N. Sankar, Christoph P. Hornik, and P Brian Smith. “Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus.Early Hum Dev 91, no. 12 (December 2015): 725–29. https://doi.org/10.1016/j.earlhumdev.2015.08.003.
Gulack BC, Laughon MM, Clark RH, Sankar MN, Hornik CP, Smith PB. Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus. Early Hum Dev. 2015 Dec;91(12):725–9.
Gulack, Brian C., et al. “Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus.Early Hum Dev, vol. 91, no. 12, Dec. 2015, pp. 725–29. Pubmed, doi:10.1016/j.earlhumdev.2015.08.003.
Gulack BC, Laughon MM, Clark RH, Sankar MN, Hornik CP, Smith PB. Comparative effectiveness and safety of indomethacin versus ibuprofen for the treatment of patent ductus arteriosus. Early Hum Dev. 2015 Dec;91(12):725–729.
Journal cover image

Published In

Early Hum Dev

DOI

EISSN

1872-6232

Publication Date

December 2015

Volume

91

Issue

12

Start / End Page

725 / 729

Location

Ireland

Related Subject Headings

  • Treatment Outcome
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn
  • Infant, Extremely Premature
  • Infant
  • Indomethacin
  • Ibuprofen
  • Humans