Letrozole Versus Mifepristone and Misoprostol in Silent Miscarriage

NCT ID: NCT06733727

Last Updated: 2024-12-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

884 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-06

Study Completion Date

2028-06-05

Brief Summary

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Management of first trimester silent miscarriage can be by expectant, medical or surgical management. Surgical management by suction evacuation is associated with surgical risks (including risks to the womb that can affect further pregnancy), anaesthetic risks and hospital stay. Medical management of first trimester silent miscarriage using misoprostol is another common option that can reduce the risk of bleeding and those associated with surgery. However, the current standard management of using misoprostol for the management of first trimester miscarriage only has a success rate of 70-80%, which is suboptimal.

Recent large studies have shown that adding mifepristone pre-treatment before misoprostol in the management of silent miscarriage can improve the success rates of complete miscarriage after medical management. There are 2 problems with mifepristone. Firstly, it is not widely available in many countries for cultural and religious reasons because it is labelled as an 'abortifacient'. Secondly, it is expensive. One tablet of Mifepristone costs $500 HK dollars. There is a need to look for an alternative to mifepristone.

Letrozole is an aromatase inhibitor which can reduce estrogen levels. Some studies have shown that it can improve the success rate of medical management of silent miscarriage and termination of pregnancy. It is safe, more widely available and cheaper than mifepristone.

This is a randomized double blinded trial comparing the use of mifepristone versus letrozole as pre-treatment in the medical management of first trimester silent miscarriage using misoprostol.

Detailed Description

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This is a randomized double blinded trial comparing the use of mifepristone versus letrozole as pre-treatment in the medical management of first trimester silent miscarriage using misoprostol.

Both groups will receive misoprostol (which is the standard management for medical management of silent miscarriage locally), but they will be randomized to either adding mifepristone or letrozole as pre-treatment. Mifepristone is usually taken once 2 days before misoprostol, whereas letrozole is taken 10mg daily for 3 days before misoprostol. Placebo of letrozole and mifepristone will be given to maintain double blindness of the groups.

Conditions

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Silent Miscarriage

Keywords

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silent miscarriage mifepristone misoprostol letrozole

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Letrozole

Letrozole 10mg per day from day 1-3 orally, placebo mifepristone Sublingual misoprostol 800 microgram on day 3

Group Type ACTIVE_COMPARATOR

Letrozole

Intervention Type DRUG

Letrozole pre-treatment in addition to misoprostol as medical management for silent miscarriage

Mifepristone

Mifepristone 200mg orally on day 1, placebo letrozole on day 1-3 Sublingual misoprostol 800 microgram on day 3

Group Type ACTIVE_COMPARATOR

Mifepristone

Intervention Type DRUG

Mifepristone pre-treatment in addition to misoprostol as medical management for silent miscarriage

Interventions

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Letrozole

Letrozole pre-treatment in addition to misoprostol as medical management for silent miscarriage

Intervention Type DRUG

Mifepristone

Mifepristone pre-treatment in addition to misoprostol as medical management for silent miscarriage

Intervention Type DRUG

Other Intervention Names

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Mifepristone, RU486

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with silent miscarriage \<= 12 weeks of gestation by ultrasonography
* Single intrauterine gestational sac
* No heavy per-vaginal bleeding
* No severe abdominal pain
* No features of intrauterine infection
* Able to understand the proposed research and able to comply with instructions
* Having given voluntary written informed consent

Exclusion Criteria

* Known allergy to mifepristone, misoprostol or letrozole
* On drugs with potential drug interactions with mifepristone e.g. aspirin, clopidogrel, anti-coagulants etc.
* Suspected ectopic or molar pregnancy or multiple pregnancy
* Distorted uterine cavity by uterine septum or submucosal fibroids
* Presence of intrauterine contraceptive device
* History of bleeding tendencies e.g. haemorrhagic diseases, current anti-coagulant treatment
* Previous history of retained products of gestation/ failed medical management of miscarriage
* Opt for expectant or surgical management of miscarriage
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Queen Mary Hospital, Hong Kong

OTHER

Sponsor Role collaborator

Pamela Youde Nethersole Eastern Hospital

OTHER

Sponsor Role collaborator

Kwong Wah Hospital

OTHER

Sponsor Role collaborator

Princess Margaret Hospital, Canada

OTHER

Sponsor Role collaborator

The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jennifer Ko

Role: PRINCIPAL_INVESTIGATOR

The University of Hong Kong

Central Contacts

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Jennifer Ko

Role: CONTACT

Phone: 22554647

Email: [email protected]

Other Identifiers

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UW22-530

Identifier Type: -

Identifier Source: org_study_id