Patients treated with mifepristone plus misoprostol for early pregnancy loss were less likely to require subsequent procedures or emergency department visits compared with those treated with misoprostol alone, according to a recent study.
In the study, published in JAMA Network Open, investigators compared outcomes of early pregnancy loss (EPL) management with mifepristone plus misoprostol vs misoprostol alone. The cohort study included 31,977 patients with average age of 32.7 years (standard deviation = 5.6 years) diagnosed with EPL between 2015 and 2022. The patients subsequently received medication treatment for EPL.
The use of mifepristone was more prevalent in urban areas compared with in non-urban areas (3.2% vs 2.5%) and was more commonly prescribed in the Northeast (8.9%) and West (5.5%) regions compared with the North Central (1.5%) and South (0.7%) regions of the United States (all P < .001).
The results showed that management with misoprostol alone was associated with an increased likelihood of requiring subsequent procedural interventions such as uterine aspiration as well as a higher incidence of emergency department (ED) visits. The patients who received mifepristone plus misoprostol had a lower rate of subsequent uterine aspiration (10.5% vs 14.0%, P = .002) and fewer ED visits (3.5% vs 7.9%, P < .001) compared with those who received misoprostol alone. Multivariable analysis indicated that patients receiving mifepristone plus misoprostol had a lower risk of requiring subsequent procedural management (adjusted odds ratio = 0.71, 95% confidence interval = 0.57–0.87).
Although prior studies have demonstrated the efficacy of combination therapy, only 3% of the patients involved in the study received mifepristone plus misoprostol, indicating its underutilization in the United States for EPL management. Regulatory factors have been identified as potential barriers to its use.
Full disclosures can be found in the published study.