Medical abortion at 57 to 63 days' gestation with a lower dose of mifepristone and gemeprost - A randomized controlled trial

Objective. To compare the abortifacient efficacy and side-effects of 200 mg and 600 mg of mifepristone, followed by gemeprost 1 mg vaginally, at 57 to 63 days' gestation. Design. Double-blind, randomized controlled trial. Setting. Ten international centers. Subjects. Eight hundred and ninety-six healthy women requesting medical abo rtion. Interventions. Participants were randomly assigned to receive a single oral dose of mifepristone of either 200 mg or 600 mg followed in 48 h by gemepr ost 1 mg vaginally. The allocation sequence was concealed by using a centra l pharmacy, and double masking was maintained throughout the study. Main outcome measures. Complete abortion rate was the principal outcome mea sure. We also evaluated the incidence of side-effects and time to abort. Results. The complete abortion rate with the lower dose of mifepristone was similar to that with the higher dose (92.4% vs. 91.7%). The relative risk of failure to achieve a complete abortion with the 200 mg dose compared to 600 mg dose was 0.9 (95% CI 0.6-1.4). The timing of the abortion and the in cidence of side-effects were comparable in both groups, with the exception of reported nausea at one-week follow-up which was reported more frequently by women in the higher-dose group. Conclusions. The 200 mg dose of mifepristone is equally as effective as the 600 mg dose in the antiprogestogen-prostaglandin regimen for pregnancy ter mination. With vaginal gemeprost, the abortifacient efficacy of the regimen remains high at 57-63 days' gestation.