Letrozole boosts misoprostol efficacy in medical abortion

  • J Matern Fetal Neonatal Med

  • International Clinical Digest
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Takeaway

  • Adding letrozole to the misoprostol regimen for medical abortion significantly increases the already high success rate with 2 doses of misoprostol alone.
  • This systematic review and meta-analysis did not find any differences in other outcomes or side-effect or complication rates.

Why this matters

  • Letrozole supplementation of misoprostol for medical abortion has been a matter of controversy, with some conflicting results about the efficacy of the combination.

Key results

  • Among the 555 patients in the 6 included randomized controlled trials, compared with controls, letrozole addition was linked to increased likelihood of completed abortion: 
    • Risk ratio, 1.38 (95% CI, 1.07-1.78; P=.01).
  • As would be expected, estradiol levels also decreased with letrozole.
  • No effect on time to induction of abortion, progesterone levels, vaginal hemorrhage, or nausea and vomiting.
  • Heterogeneity among the studies was high (I2, 73%; P=.01).

Study design

  • Meta-analysis of 6 randomized controlled trials; random-effect model applied.
  • Funding: None disclosed.

Limitations

  • 3 of 6 trials had small numbers,
  • Letrozole dose, duration varied.