From the Research
Progesterone is not recommended as a standard treatment for traumatic brain injury (TBI) due to inconsistent evidence and lack of significant improvement in outcomes in larger phase III clinical trials. The most recent and highest quality study, a 2016 Cochrane review 1, found no evidence of a difference in overall mortality or disability between the progesterone group and placebo group. This review included five randomized controlled trials with a total of 2392 participants and found low-quality evidence for no difference in overall mortality (RR 0.91,95% CI 0.65 to 1.28) and moderate-quality evidence for no difference in disability (RR 0.98,95% CI 0.89 to 1.06).
Some earlier studies suggested potential benefits of progesterone in TBI, such as a 2007 pilot clinical trial 2 that found a lower 30-day mortality rate in the progesterone group, and a 2008 randomized controlled trial 3 that found improved neurologic outcomes and lower mortality rates in the progesterone group. However, these findings were not consistent across all studies, and the 2016 Cochrane review 1 found no evidence to support the use of progesterone for TBI.
Key points to consider:
- The evidence for progesterone in TBI is inconsistent and of low to moderate quality.
- Larger phase III clinical trials have failed to demonstrate significant improvement in outcomes.
- Progesterone's potential benefits stem from its anti-inflammatory properties, ability to reduce excitotoxicity, decrease free radical damage, and prevent neuronal death.
- Further research is needed to explore whether specific TBI subgroups might benefit from progesterone therapy or if different dosing regimens might prove more effective.
In clinical practice, the decision to use progesterone for TBI should be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential risks and benefits of treatment. However, based on the current evidence, progesterone is not recommended as a standard treatment for TBI 1.