A commentary notes that despite these findings, there are drug differences. Atosiban is licensed in the EU for threatened preterm birth, administered intravenously, and costs £70 for 48 hours treatment, whereas oral nifedipine is licensed only as an antihypertensive drug and therefore used off-label and costs £1.30. Its suggests that in the US where atosiban remains unlicensed for preterm birth and any other indication and therefore unavailable even off-label, and in countries with budgetary constraints, nifedipine is likely to be the drug of choice. In other countries, there may be reluctance to use an unlicensed agent. The commentators state that cost and licensing status are not the most important issue but the fact that no trial has ever convincingly shown a tocolytic drug to reduce any important adverse outcomes as compared with placebo or no treatment. Older trials of tocolysis might have had negative results because they were too small or because they failed to exclude participants with underlying foetal compromise. They add “with the differing licensing status of the drugs in the two continents, perhaps North American obstetricians should run a large nifedipine versus placebo trial and European obstetricians run an atosiban versus placebo one. Given the global burden of preterm birth, both are long overdue.”