New research finds Mifepristone a viable alternative to abortion

A new study suggests a possible alternative to the abortion pill mifepristone, a drug that continues to be the target of lawsuits and legislation from abortion opponents.

But its potential replacement could complicate reproductive health policy because it’s also the main ingredient in the morning-after pill.

The new study, published Thursday in the journal NEJM Evidence, involved a drug called ulipristal acetate, the active ingredient in the prescription contraceptive Ella, one of two types of morning-after pills approved in the United States. . (The other, Plan B One-Step, which does not require a prescription, contains other drugs and does not work in a way that can stop pregnancy, according to scientific evidence.)

In the study, 133 women who were pregnant up to nine weeks took twice the dose of ulipristal acetate contained in Ella, followed by misoprostol, the second drug used in conventional abortion treatment. All but four women completed the termination of pregnancy without further intervention, a completion rate of 97 percent which is similar to treatment using mifepristone. (Others have completed the process with additional medications or medical procedures.)

There were no major complications, and the study concluded that the use of ulipristal acetate for abortion is safe.

Dr. Beverly Winikoff, lead author of the study and president of Gynuity Health Projects, a reproductive health research organization, said that after the Supreme Court struck down the nation’s right to abortion in 2022, then he began to wonder about the potential role of ulipristal acetate. , which has the same chemical structure as mifepristone.

“I thought maybe there was something else we could do,” he said. “Another option. And this one is already on the market. “

The political implications of the study are complicated by their ability to blur the lines between public perception of emergency contraception and abortion. For years, anti-abortionists have opposed morning-after pills on the grounds that they can cause abortions, and reproductive health experts have countered by pointing to scientific evidence. but the pill does not prevent pregnancy but prevents pregnancy after intercourse.

Some reproductive health experts worry that research showing that ingredients in the morning-after pill can be used to induce abortions could fuel efforts to curb emergency contraception and sow confusion that may strengthen anti-abortion strategies.

Kristi Hamrick, spokeswoman for Students for Life of America, said her organization “really” to consider Ella’s trial.

“Pro-life actions should be justified,” Ms Hamrick said. “We’ve been arguing for years that Ella is having an abortion.”

Mary Ziegler, a law professor and abortion expert at the University of California, Davis, said the study could pose challenges to both sides of the abortion debate.

“It’s going to put wind in the sails of the anti-abortionists who have said things like birth control can be abortifacients,” he said, adding: “This published study is going to be difficult, I think, for supporters of Abortion rights govern.”

But Ms. Ziegler said the survey results could also be “politically dangerous” for abortion opponents because public support for contraception is high and many voters in the U.S. the conservative state supported the vote to protect abortion rights. “I think it’s one of the things that will tempt social conservatives to push faster than the current policy of controlling contraception,” he said. “And I think it might backfire.”

Reproductive health experts said the new study did not challenge the science showing that the morning-after pill does not cause abortions, because there are different doses of the drug.

Abortion opponents said they were not surprised by the survey’s findings.

“After years of denying the ability of ulipristal acetate to end the life of an embryo, abortion advocates are beginning to use it as an alternative to the abortion drug mifepristone,” Dr. Donna Harrison, director of research at the American Pro-Life Association. Obstetricians and gynecologists, said the statement. “The reason for this is simple. Ulipristal and mifepristone work in the same way.

Ella has already been targeted by some conservatives. Project 2025, a right-wing political plan with strong ties to the new Trump administration, said Ella should be excluded from essential contraceptive coverage because it “could be an abortion.”

Mifepristone, the first pill in a common two-drug abortion regimen, is the only drug specifically approved for abortion in the United States. Usually used during the 12th week of pregnancy, mifepristone stops the development of the pregnancy by blocking the hormone progesterone. The second drug, misoprostol, is taken 24 to 48 hours later and causes the same reduction as in infancy.

Ulipristal acetate is in the same drug class as mifepristone and blocks the action of progesterone, a hormone that prepares the uterus to receive and hold an embryo, said Dr. Daniel Grossman, a reproductive health doctor and researcher at the University of California, San Francisco, who was not involved in the new study.

In the study, a dose of 60 milligrams of ulipristal acetate (double the 30 milligrams of Ella) was replaced by mifepristone and followed by misoprostol, which has various clinical uses and less was too targeted at the anti-abortionists. (Misoprostol can also facilitate abortion on its own, but is thought to be more effective in combination therapy.)

Reproductive health experts said they welcomed the finding of an alternative to mifepristone as abortion opponents have made efforts to severely restrict the drug across the country, particularly in the face of federal lawsuits against Food and Drug Administration. The Supreme Court dismissed that lawsuit last year, saying the original plaintiffs lacked standing to sue, but the suit was refiled with three states as plaintiffs.

Dr. Grossman, who co-authored the study, said the prospect of replacing mifepristone was “certainly promising.” But, he added, “if because of this new evidence that at higher doses, ulipristal acetate can cause abortion, which will lead to ulipristal acetate being removed from the emergency contraceptive market, then It’s really bad.”

The company that makes Ella, Perrigo, released a statement saying that Ella was “not tested in this study.” He added, “Ella is an FDA-approved emergency contraceptive pill that works before pregnancy occurs,” he continued. “There is no evidence yet that Ella alone causes abortions.”

The study was conducted in Mexico City and co-led by the researchers there.

Several experts have said that since the first small study without a comparison group of patients, more research is needed before using ulipristal acetate for abortion. “We cannot change medical practice based on this study,” said Kelly Cleland, a researcher who is the executive director of the American Society for Emergency Contraception.

Scientists have long understood that drugs based on hormones may be able to perform different functions at different doses in the field of reproductive health cycles.

In Europe, researchers including Dr. Rebecca Gomperts, a Dutch doctor and founder of a telemedicine organization that provides abortion pills worldwide, is studying low doses of mifepristone as a weekly birth control pill. Said Dr. Gomperts thought that the new ulipristal acetate study was enough to prescribe the drug off-label for abortion.

“The more use we have of these drugs, the harder it will be for people to get off them,” said Dr. Paul Blumenthal, professor emeritus of obstetrics and gynecology at Stanford University who was on the study’s advisory group.

Plan B is the morning-after pill in the US, but Ella is considered more effective for some women, including those who are overweight. Plan B is meant to be taken within three days of unprotected sex, while Ella can be taken within five days.

Both pills prevent pregnancy by blocking ovulation, the release of an egg from the ovary that occurs before ovulation, according to scientific studies.

Some abortion opponents claim that the morning after pill is an abortifacient based on the theory that it may prevent a fertilized egg from entering the womb. Most scientific research has not found this.

For years, despite the scientific evidence to the contrary detailed in an investigation by The New York Times, the label and packaging approved by the FDA for Plan B One-Step said that although the pill worked to prevent ovulation, it had the potential to prevent implantation. . In 2022, the agency changed the language to clarify that Plan B only works before conception, “will not work if you are already pregnant, and will not affect an existing pregnancy.”

The FDA label for Ella states that the “primary mechanism” is to stop or delay ovulation. The label adds that the drug may affect implantation. Studies in recent years, however, suggest that Ella does not work to prevent a fertilized egg from implanting in the womb.