title: The added value of mifepristone to non-surgical treatment regimens for uterine evacuation in case of early pregnancy failure: a systematic review of the literature.
abstract: OBJECTIVE
  Early pregnancy failure (EPF) is a common complication of pregnancy. Surgical intervention carries a risk of complications and, therefore, medical treatment appears to be a safe alternative. Unfortunately, the current medical treatment with misoprostol alone has complete evacuation rates between 53% and 87%. Some reports suggest that sequential treatment with mifepristone and misoprostol leads to higher success rates than misoprostol alone.
  
  
  METHODS
  To evaluate the added value of mifepristone to current non-surgical treatment regimens in women with EPF we performed a systematic literature search. Electronic databases were searched: PubMed, Cochrane Library, Current Controlled Trials, and ClinicalTrials.gov. Clinical studies, both randomised and non-randomised trials, reporting on the added value of mifepristone to current non-surgical treatment regimens in women with EPF were included. Data of sixteen studies were extracted using a data extraction sheet (based on the Cochrane Consumers and Communication Review Group's data extraction template). The methodological quality was assessed using the Cochrane Collaboration Risk of Bias tool.
  
  
  RESULTS
  In five randomised and eleven non-randomised trials, success rates of sequential treatment with mifepristone and misoprostol in case of EPF varied between 52% and 95%. Large heterogeneity existed in treatment regimens and comparators between studies.
  
  
  CONCLUSIONS
  The existing evidence is insufficient to draw firm conclusions about the added value of mifepristone to misoprostol alone. A sufficiently powered randomised, double blinded placebo-controlled trial is urgently required to test whether, in EPF, the sequential combination of mifepristone with misoprostol is superior to misoprostol only.
authors.affiliation: Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Postbus 9015, 6500 GS Nijmegen, The Netherlands. Electronic address: menm.trial@gmail.com.
authors.forename: Joyce
authors.initials: J
authors.lastname: van den Berg
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Bernardus B M
authors.initials: BBM
authors.lastname: Gordon
authors.affiliation: Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Postbus 9015, 6500 GS Nijmegen, The Netherlands.
authors.forename: Marcus P M L
authors.initials: MPML
authors.lastname: Snijders
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Frank P H A
authors.initials: FPHA
authors.lastname: Vandenbussche
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Sjors F P J
authors.initials: SFPJ
authors.lastname: Coppus
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000021:Abortifacient Agents, Steroidal / Q000627:therapeutic use*; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000627:therapeutic use*; D016595:Misoprostol / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone
keywords: Early pregnancy failure; Mifepristone; Misoprostol