Timing and efficacy of mifepristone pretreatment for medical management of early pregnancy loss

Flynn, Anne N.; Roe, Andrea H.; Koelper, Nathanael; McAllister, Arden; Sammel, Mary D.; Schreiber, Courtney A.

doi:10.1016/j.contraception.2021.01.007

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Similar findings were noted in a study with the same regimen in the United Kingdom 47 . Secondary analysis of these findings has indicated that misoprostol may be able to be administered as soon as 7 to 20 hours after mifepristone for the highest likelihood of success 48 . Use of mifepristone in conjunction with misoprostol is also cost-effective as compared with misoprostol alone with an incremental cost-effectiveness ratio of greater than $4000 per quality-adjusted life-year gained 49 .…”

Section: Obstetric Uses Of Mifepristonesupporting

confidence: 68%

“…47 Secondary analysis of these findings has indicated that misoprostol may be able to be administered as soon as 7 to 20 hours after mifepristone for the highest likelihood of success. 48 Use of mifepristone in conjunction with misoprostol is also cost-effective as compared with misoprostol alone with an incremental cost-effectiveness ratio of greater than $4000 per quality-adjusted life-year gained. 49 Based on this evidence, the American College of Obstetricians and Gynecologists recommends consideration of a dose of mifepristone 200 mg orally 24 hours before misoprostol when available for medical management of early pregnancy loss.…”

Section: Early Pregnancy Lossmentioning

confidence: 99%

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Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology

Hagey

Givens

Bryant

2022

Obstetrical &Amp; Gynecological Survey

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Importance: Mifepristone (RU-486) is a selective progesterone receptor modulator that has antagonist properties on the uterus and cervix. Mifepristone is an effective abortifacient, prompting limitations on its use in many countries. Mifepristone has many uses outside of induced abortion, but these are less well known and underutilized by clinicians because of challenges in accessing and prescribing this medication.Objective: To provide clinicians with a history of the development of mifepristone and mechanism of action and safety profile, as well as detail current research on uses of mifepristone in both obstetrics and gynecology.Evidence Acquisition: A PubMed search of mifepristone and gynecologic and obstetric conditions was conducted between January 2018 and December 2021. Other resources were also searched, including guidelines from the American College of Obstetricians and Gynecologists and the Society of Family Planning.Results: Mifepristone is approved by the Food and Drug Administration for first-trimester medication abortion but has other off-label uses in both obstetrics and gynecology. Obstetric uses that have been investigated include management of early pregnancy loss, intrauterine fetal demise, treatment of ectopic pregnancy, and labor induction. Gynecologic uses that have been investigated include contraception, treatment of abnormal uterine bleeding, and as an adjunct in treatment of gynecologic cancers.Conclusions and Relevance: Mifepristone is a safe and effective medication both for its approved use in first-trimester medication abortion and other off-label uses. Because of its primary use as an abortifacient, mifepristone is underutilized by clinicians. Providers should consider mifepristone for other indications as clinically appropriate.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After completing this activity, the learner should be better able to describe the history of the development of mifepristone, including its mechanism of action and safety profile; and explain the uses for mifepristone in both obstetrics and gynecology.Jill M. Hagey and Amy G. Bryant have disclosed that the U.S. Food and Drug Administration has not approved the use of any drugs or devices for the treatment of early pregnancy loss, intrauterine fetal demise, ectopic pregnancy, pregnancy prevention, abnormal uterine bleeding, or gynecologic cancers as discussed in this article. Please consult the product's labeling for approved information.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

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Section: Obstetric Uses Of Mifepristonesupporting

confidence: 68%

Section: Early Pregnancy Lossmentioning

confidence: 99%

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology

Hagey

Givens

Bryant

2022

Obstetrical &Amp; Gynecological Survey

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“…Throughout the search and selection of studies, seven articles, 13 14 15 16 17 18 19 which compared mifepristone and misoprostol, were analyzed. However, these were discarded because they did not meet the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

Silva,

Araujo,

Simões

et al. 2023

Rev Bras Ginecol Obstet

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Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07–0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96–4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52–0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.

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“…In the current politicolegal environment in the United States, an increasing number of states have adopted abortion restrictions similar to those of Alabama, 18 which affects the evidence-based provision of abortion-adjacent care, including miscarriage management. In addition to the combination of mifepristone-misoprostol being more efficacious 19,20 than misoprostol alone, recent research suggests that it is more cost-effective 6 on a population level and additionally may result in better patient experiences. A recent study of misoprostol-only abortion care in the setting of legislation limiting access to mifepristone included an interview with a patient who reported a significantly better experience with mifepristone added as compared with a misoprostol-only regimen, calling it “a world of difference” 21 .…”

Section: Discussionmentioning

confidence: 99%

Abortion Stigma as a Barrier to Mifepristone Use among Obstetrician-Gynecologists in Alabama for Early Pregnancy Loss

Mokashi,

Boulineaux,

Janiak

et al. 2024

Southern Medical Journal

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Timing and efficacy of mifepristone pretreatment for medical management of early pregnancy loss

Cited by 8 publications

References 16 publications

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

Abortion Stigma as a Barrier to Mifepristone Use among Obstetrician-Gynecologists in Alabama for Early Pregnancy Loss

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