Traumatic brain injury is one of the main causes of death and disability. Besides the primary brain damage, secondary brain damage caused by mechanisms such as brain oedema, free radical formation or release of inflammatory mediators may exacerbate the injury. Progesterone is a potential drug for reducing secondary damage caused by several of these mechanisms. It has been shown to reduce the consequences of the injury cascade by decreasing brain oedema; enhancing antioxidant mechanisms and reducing excitotoxicity in animals.
The authors of this review searched for all randomised controlled trials looking at the effects of progesterone on mortality and disability in patients with traumatic brain injury. They focused their search on randomised controlled trials in which in addition to standard treatment the experiment group received progesterone and the control group received non-active treatment (placebo) or no treatment. The review authors found three studies with a total of 315 patients, and one ongoing study. There was some evidence of a beneficial effect of progesterone on mortality and disability in patients with traumatic brain injury. The results of this review indicate that progesterone may reduce mortality and disability compared to the control group with no additional adverse events, but the evidence is still insufficient due to the small number of trial participants.
Progesterone is probably a beneficial drug for patients with traumatic brain injury, but more research should be done, especially multicentre studies. The findings of the ongoing multicentre study sponsored by Emory University will enhance the evidence for this research, and the results will be incorporated into this review when released.