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Annals of Family Medicine 2023
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Mifepristone; Abortion, Induced
PubMed: 37100465
DOI: 10.1370/afm.3006 -
Current Opinion in Endocrinology,... Aug 2012Mifepristone is the first and only available glucocorticoid receptor antagonist. Cushing's syndrome is a rare disease, responsible for increased morbidity and mortality.... (Review)
Review
PURPOSE OF REVIEW
Mifepristone is the first and only available glucocorticoid receptor antagonist. Cushing's syndrome is a rare disease, responsible for increased morbidity and mortality. The treatment of Cushing's syndrome is far from perfect. The aim of this review is to better define the merits and pitfalls of mifepristone in treating Cushing's syndrome, and try to determine its potential roles in the treatment of hypercortisolism.
RECENT FINDINGS
Only case reports or series based on a low number of patients had been reported in the literature. A recent retrospective European Study based on about 20 patients with Cushing's syndrome gave more precise data about mifepristone. Coupled with the 20 previously reported patients in various studies, these results determine the profile of patients who could benefit from mifepristone.
SUMMARY
High clinical efficacy of mifepristone is counterbalanced by the lack of available biological monitoring data during treatment, and the risk of worsening of hypokalemia and blood pressure levels. However, its rapid efficacy and the fact that the drug uses a mechanism that is different from all currently available treatment should make mifepristone a valuable treatment in particular cases of uncontrolled hypercortisolism despite classical methods.
Topics: Adolescent; Adult; Blood Pressure; Child, Preschool; Cushing Syndrome; Female; Hormone Antagonists; Humans; Hypokalemia; Male; Middle Aged; Mifepristone; Receptors, Glucocorticoid; Young Adult
PubMed: 22543346
DOI: 10.1097/MED.0b013e32835430bf -
Fertility and Sterility Sep 1991The availability of a medical mode of termination of early pregnancy by the administration of RU486, an antiprogesterone alone, or in combination with one of the PG... (Review)
Review
The availability of a medical mode of termination of early pregnancy by the administration of RU486, an antiprogesterone alone, or in combination with one of the PG analogues significantly reduces the maternal morbidity and mortality associated with the classical surgical abortion. RU486 given alone in early pregnancy induces complete abortion in 60% to 85% of cases, and when combined with prostaglandin analogues, gemeprost or sulprostone, reaches a success rate of 95% to 99%. RU486 may also be of potential value in the medical treatment of ectopic pregnancy. Its use as a postcoital contraception is suggested, but further research is required to determine whether RU486 can be used on a once-a-month basis for contraception.
Topics: Abortion, Induced; Adrenal Cortex; Animals; Contraceptives, Postcoital; Drug Combinations; Endometrium; Female; Humans; Hypothalamo-Hypophyseal System; Mifepristone; Ovary; Pregnancy; Prostaglandins
PubMed: 1894013
DOI: 10.1016/s0015-0282(16)54527-0 -
The Journal of Pharmacology and... Nov 2020The efficacy of short-term treatment with mifepristone (MIFE), a high-affinity, nonselective glucocorticoid receptor antagonist, to reduce ethanol drinking was tested in...
The efficacy of short-term treatment with mifepristone (MIFE), a high-affinity, nonselective glucocorticoid receptor antagonist, to reduce ethanol drinking was tested in a rhesus macaque model. Stable individual daily ethanol intakes were established, ranging from 1.6 to 4.0 g/kg per day ( = 9 monkeys). After establishment of chronic ethanol intake, a MIFE dosing regimen that modeled a study of rodent drinking and human alcohol craving was evaluated. Three doses of MIFE (17, 30, and 56 mg/kg per day) were each administered for four consecutive days. Both 30 and 56 mg/kg decreased ethanol intake compared with baseline drinking levels without a change in water intake. The dose of 56 mg/kg per day of MIFE produced the largest reduction in ethanol self-administration, with the average intake at 57% of baseline intakes. Cortisol was elevated during MIFE dosing, and a mediation analysis revealed that the effect on ethanol drinking was fully mediated through cortisol. During a forced abstinence phase, access to 1.5 g/kg ethanol resulted in relapse in all drinkers and was not altered by treatment with 56 mg/kg MIFE. Overall, these results show that during active drinking MIFE is efficacious in reducing heavy alcohol intake in a monkey model, an effect that was related to MIFE-induced increase in cortisol. However, MIFE treatment did not eliminate ethanol drinking. Further, cessation of MIFE treatment resulted in a rapid return to baseline intakes, and MIFE was not effective in preventing a relapse during early abstinence. SIGNIFICANCE STATEMENT: Mifepristone reliably decreases average daily ethanol self-administration in a nonhuman primate model. This effect was mediated by cortisol, was most effective during open-access conditions, and did not prevent or reduce relapse drinking.
Topics: Alcohol Drinking; Animals; Drinking; Macaca mulatta; Male; Mifepristone; Self Administration
PubMed: 32873623
DOI: 10.1124/jpet.120.000169 -
Contraception Mar 2022To evaluate whether same-day administration of mifepristone and misoprostol, compared with misoprostol alone, reduces the duration of second-trimester induction of labor...
OBJECTIVE
To evaluate whether same-day administration of mifepristone and misoprostol, compared with misoprostol alone, reduces the duration of second-trimester induction of labor for termination of pregnancy or increases the rate of fetal expulsion within 24 hours.
STUDY DESIGN
We conducted a retrospective analysis of patients undergoing induction of labor for pregnancy termination in the second trimester between 2009 and 2018. We compared patients who received mifepristone on the same day as the first dose of misoprostol to those who received misoprostol alone. The primary outcome was expulsion within 24 hours after the first dose of misoprostol.
RESULTS
Two hundred ninety-eight patients met criteria for inclusion, of whom 94 (31.5%) received same-day mifepristone. Expulsion within 24 hours occurred in 93.6% of the mifepristone-plus-misoprostol group and 79.9% of the misoprostol-only group (RR 1.17, 95%CI 1.07-1.28). Expulsion within 12 hours occurred in 56.4% of the mifepristone-plus-misoprostol group and 34.0% of the misoprostol-only group (RR 1.66, 95%CI 1.28-2.16). After adjusting for demographic and clinical characteristics, the rate of expulsion within 24 hours was similar between groups (RR 1.07, 95%CI 0.92-1.26), while the rate of expulsion within 12 hours remained different (RR 1.69, 95%CI 1.01-2.83). Median time to expulsion was shorter in the mifepristone-plus-misoprostol group than the misoprostol-only group (689 minutes vs 901 minutes, p < 0.001).
CONCLUSION(S)
Patients who received mifepristone on the same day as misoprostol had a shorter duration of induction termination and higher rate of success within 12 hours.
Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies
PubMed: 34529952
DOI: 10.1016/j.contraception.2021.09.006 -
Human Reproduction (Oxford, England) Jun 1994Mifepristone administration to women in the mid- or late follicular phase delays the luteinizing hormone (LH) surge and prolongs the follicular phase. Since the... (Review)
Review
Mifepristone administration to women in the mid- or late follicular phase delays the luteinizing hormone (LH) surge and prolongs the follicular phase. Since the resumption of follicular growth commences following mifepristone cessation, the drug must be given either continuously or at repeated intervals in order to block ovulation. Using various regimens with or without exogenous progestins, ovulation was inhibited in the majority of subjects. However, this was not consistent and in several instances, LH surges and a rise in plasma progesterone were suggestive of ovulation and corpus luteum function. Therefore, mifepristone cannot be used as a contraceptive which will reliably inhibit ovulation. With low-dose mifepristone administration, alterations in endometrial morphology were characterized by a delay in maturation despite the presence of ovulation. This suggests that the endometrium displays a greater sensitivity to mifepristone than does the pituitary, a finding that may have important contraceptive implications. Late luteal-phase mifepristone administration to women who were not sexually active did not alter their menstrual rhythm, bleeding patterns or steroid and gonadotrophin concentrations. However, when used in unprotected women in the late luteal phase, mifepristone did not uniformly terminate all pregnancies. On the other hand, when used within 72 h of intercourse, mifepristone was as effective a post-coital agent as the standard high-dose oestrogen-progestin combination.
Topics: Abortion, Induced; Contraceptives, Postcoital; Corpus Luteum Maintenance; Drug Administration Schedule; Endometrium; Female; Follicular Phase; Humans; Luteal Phase; Menstruation-Inducing Agents; Mifepristone; Ovulation; Pregnancy; Progesterone Congeners; Treatment Failure
PubMed: 7962472
DOI: 10.1093/humrep/9.suppl_1.69 -
Journal of Obstetrics and Gynaecology... Dec 2020Abortion-related complications remain one of the leading causes of maternal morbidity and mortality worldwide. Nearly half of all abortions are unsafe, and the vast... (Review)
Review
OBJECTIVE
Abortion-related complications remain one of the leading causes of maternal morbidity and mortality worldwide. Nearly half of all abortions are unsafe, and the vast majority of these occur in low- and middle-income countries. The use of mifepristone with misoprostol for medical abortion has been proposed and implemented to improve abortion safety.
DATA SOURCES
A systematic review of the literature was conducted in PubMed, Embase, Cochrane, and CINAHL.
STUDY SELECTION
Criteria for study inclusion were first-trimester abortion, use of mifepristone with misoprostol, and low- or middle-income country status as designated by the World Health Organization.
DATA EXTRACTION
Results for effectiveness, safety, acceptability, and qualitative information were assessed.
DATA SYNTHESIS
The literature search resulted in 181 eligible articles, 52 of which met our criteria for inclusion. A total of 34 publications reported effectiveness data on 25 385 medical abortions. The average effectiveness rate with mifepristone 200 mg and misoprostol 800 µg was 95% up to 63 days gestation. A sensitivity analysis was performed to assume that all women lost to follow-up failed treatment, and the recalculated effectiveness rate remained high at 93%. The average continuing pregnancy rate was 0.6%. A total of 22 publications reported safety and acceptability data on 17 381 medical abortions. Only 0.8% abortions required presentation to hospital, and 87% of patients found the side effects of treatment acceptable. Overall, 95% of women were satisfied with their medical abortion, 94% would choose the method again, and 94% would recommend this method to a friend. A total of 16 publications reported qualitative results and the majority supported positive patient experiences with medical abortion.
CONCLUSIONS
Mifepristone and misoprostol is highly effective, safe, and acceptable to women in low- and middle-income countries, making it a feasible option for reducing maternal morbidity and mortality worldwide.
Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Developing Countries; Female; Humans; Mifepristone; Misoprostol; Patient Acceptance of Health Care; Pregnancy; Treatment Outcome
PubMed: 32912726
DOI: 10.1016/j.jogc.2020.04.006 -
Women's Health Issues : Official... 1993
Review
Topics: Abortion, Induced; Clinical Trials as Topic; Contraceptives, Postcoital; Female; Humans; Mifepristone; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Vacuum Curettage
PubMed: 8274873
DOI: 10.1016/s1049-3867(05)80252-x -
Women's Health (London, England) Jan 2011China was the first country in the world that approved mifepristone (RU-486) for abortion. A total of 6 years after the report published in the Western world indicated... (Review)
Review
China was the first country in the world that approved mifepristone (RU-486) for abortion. A total of 6 years after the report published in the Western world indicated that mifepristone may also be effective in treating endometriosis, the first paper on the same topic was published in China in 1997. Since then, over 160 studies on this topic have been published in China. We retrieved 104 papers on clinical trials and trial-like studies conducted in China evaluating the use of mifepristone to treat endometriosis that were published in the last 11 years. We found that the quality of these studies is well below an acceptable level, making it difficult to judge whether mifepristone is truly efficacious. There are intriguing signs that these studies, as a whole, have serious anomalies. The areas that are glaringly deficient are informed consent, choice of outcome measures, the evaluation of outcome measures, data analysis and randomization. The uniformly low quality is disquieting, given the large quantity of studies, the enormous amount of resource and energy put into these studies and, above all, the weighty issue of treatment efficacy that concerns each and every patient with endometriosis. Equally disquieting are the low-quality repetition, the absence of a critical, systematic review on the subject, the lack of suggestions for multicenter clinical trials and the seemingly unnecessary duplication of clinical trials without due informed consent. In view of this, it may be time to institute changes in attitude and practice, and to change education and training programs in the methodology of clinical trials in obstetrics and gynecology research in China.
Topics: China; Clinical Trials as Topic; Endometriosis; Female; Humans; Mifepristone; Pregnancy
PubMed: 21175391
DOI: 10.2217/whe.10.79 -
Gynecologie, Obstetrique & Fertilite Jun 2008Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours' growth by several pathways. Its efficiency has been widely evaluated in... (Review)
Review
Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours' growth by several pathways. Its efficiency has been widely evaluated in symptomatic patients for more than 10 years. A significant decrease in fibroid tumours and uterine volume concomitant with better quality of life scores can be obtained with a daily administration of Mifepristone 5mg. Mifepristone can be compared with GnRH agonists in terms of efficiency. Observed adverse outcomes are hot flushes (38%), elevated hepatic enzymes (4%) and benign endometrial hyperplasia (28%). Hot flushes and endometrial hyperplasia are not observed with 5mg daily doses. Data suggest that many invasive procedures could be avoided with the routine use of Mifepristone for fibroid tumours care. However, published study periods are only three to 12 months: long lasting evaluation in larger groups of patients seems necessary before this treatment could be proposed as routine care.
Topics: Antineoplastic Agents, Hormonal; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Female; Hot Flashes; Humans; Leiomyoma; Liver; Mifepristone; Treatment Outcome; Uterine Neoplasms
PubMed: 18539512
DOI: 10.1016/j.gyobfe.2008.01.017