- 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.
- 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).
- Meta-analysis of 6 randomized controlled trials; random-effect model applied.
- Funding: None disclosed.
- 3 of 6 trials had small numbers,
- Letrozole dose, duration varied.