Possible Progesterone Benefits In Traumatic Brain Injury
For patients with traumatic brain injury, there are no proven neuroprotective drugs, although progesterone treatment offers some faint hope.
In a phase 2 study at Grady Memorial Hospital in Atlanta, Georgia, progesterone caused no discernible harm and showed possible signs of benefit. Seventy-seven adult trauma patients were randomly assigned to receive intravenous (IV) progesterone and 23 were assigned to placebo.
Throughout the three-day infusion interval, the progesterone group experienced a lower increase in mean temperature, compared with the placebo group. The researchers say that this is important, because the endogenous release of progesterone is associated with an increase of 1 degree Fahrenheit in core temperature, and elevated temperatures have been posited to adversely affect neurological outcomes.
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Seven placebo patients and 10 progesterone patients died within 30 days; the progesterone group had a strong trend toward fewer deaths from neurological causes. Mortality differed by severity of injury. Six of 15 patients with an index Glasgow Coma Scale score of 4 to 8 who received placebo died, as did seven of 53 patients (13%) taking progesterone. One patient of seven in the placebo group who had Glasgow Coma Scale scores of 9 to 12 died, as did three of 18 patients in the progesterone group.
The researchers noted that the survival benefit seemed highest in patients with severe traumatic brain injury. If, as the findings suggest, a higher proportion of severely injured patients treated with progesterone survived, this might explain why members of this group were comatose longer and were less likely to have moderate to good Glasgow Outcome Scale-Extended (GOS-E) scores. Patients with severe injury (index scores of 4 to 
who received progesterone remained in a coma more than twice as long as placebo patients (mean, 10 days vs. 4 days).
Thirty days after their injury, most survivors with scores of 4 to 8 were functioning at a “relatively poor” level, regardless of treatment. Only four of 15 placebo patients had GOS-E scores compatible with moderate or good recovery, compared with 11 of 52 in the progesterone group. Among patients enrolled with an index score of 9 to 12 on the Glasgow Coma Scale, none of the seven placebo patients had moderate-to-good recovery, compared with 10 of the 18 patients receiving progesterone.
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A similar relationship was seen in disability ratings. Survivors with severe injury who received placebo were slightly less disabled than those treated with progesterone. But in those with moderate traumatic brain injury, the progesterone-treated patients were significantly less disabled.
