On March 1, Cytotec, a widely used treatment for drug-induced abortions, miscarriages and triggers will be withdrawn from the market. Is this good news? What are the alternative solutions?
Each year, between 120,000 and 130,000 medical abortions are declared in France, according to the National Agency for the Safety of Medicines and Health Products (Ansm). Today, they are mostly practiced with a treatment: the Cytotec. But in fifteen days this drug will be withdrawn from the market following a controversy related to the side effects of the molecule misoprostol. But if the Pfizer lab has announced its withdrawal from the market, the lots will not be recalled.
Anti-ulcerative gynecological treatment
Cytotec has been licensed for thirty years. Originally, it is a treatment against ulcers and gastric problems. It is for this use that he has also received a marketing authorization. But it contains a molecule, misoprostol, which causes contractions of the uterus. Useful for expelling a baby during a labor release, a fetus during a miscarriage or an embryo in the event of an abortion. Today, Cytotec is used in more than 90% of cases.
Cytotec, too difficult to dose
The problem with this treatment is that it is very difficult to dose when used in gynecology. To be effective it must be administered vaginally and not orally, while it was designed for the latter use. The risks of overdose are high, since doctors must use a maximum of one eighth of the tablet, dosed at 200 microbiograms. Its very small size does not facilitate the dosage.
Withdrawn as dangerous
The Cytotec is implicated for very serious undesirable effects, especially in case of triggering, such as haemorrhages, abnormal heart rhythm of the fetus, uterine rupture ... Aurélie Joux, founder of the association "Timéo and the others" ( the name of his son born heavily disabled following an overdose of treatment) won his case against the hospital of Poissy-Saint-Germain-en-Laye (Yvelines) in 2016. This mother of the family has campaigned for the withdrawal from the market of this treatment. It's done. But now, what to do?
What alternatives to Cytotec?
There are two medicines containing misoprostol. The Gymiso of the Amring laboratory and the MisoOne of Nordic Pharma. But their marketing use (MA) only concerns drug-induced IVG. The Ansm then granted them a temporary recommendation of use (RTU) for the triggers and the miscarriages, effective, normally, on March 1st. A third drug has received marketing authorization (MA): Angusta from the Azanta laboratory. But he will not be available in France for several months.
Otherwise, there is still curettage, or "aspiration". But this intervention is far from being the most popular of women. Drug-induced abortion with Cytotec also reduced the number of curettages by three-quarters.