Oh A new study The abortion pill offers a potential alternative to mifepristone, a drug that continues to be the target of lawsuits and legislation from abortion opponents.
But the potential alternative could further complicate the politics of reproductive health because the contraceptive is also a key ingredient in the morning-after pill.
new research, Published Thursday in the journal NEJM Evidence.It contained the drug alperistal acetate, the active ingredient in the prescription contraceptive Ella, one of two types of morning-after pills approved in the United States. (The second, Plan B One Step, which does not require a prescription, involves a different drug and scientific evidence does not show it works to terminate a pregnancy.)
In the study, 133 women who were nine weeks pregnant took two doses of ulipristal acetate, which is in Ella, followed by misoprostol, another drug used in common abortion procedures. All but four women terminated their pregnancies without intervention, a 97 percent completion rate similar to the mifepristone regimen. (Others ended the process with additional medication or procedures.)
There were no serious complications, and the study concluded that the use of alperistal acetate in a two-drug abortion procedure was safe.
Dr. Beverly Vinicoff, lead author of the study and president of the reproductive health research organization Gynuity Health Projects, said that after the Supreme Court struck down the national right to abortion in 2022, she was concerned about the potential role of ulipristal acetate. started thinking about , which has a similar chemical structure to mifepristone.
“I was thinking, maybe we can do something else,” she said. “Another option. And it’s already on the market.”
The political implications of the study are complicated by their potential to blur the line between public perception of emergency contraception and abortion. For years, abortion opponents have opposed the morning-after pill, saying it can cause miscarriage, and reproductive health experts have countered it by pointing to scientific evidence that the pill can prevent pregnancy. They do not terminate but work to prevent pregnancy after intercourse.
Some reproductive health experts are concerned that research showing that the morning-after pill component can be used to induce abortions could hinder efforts to prevent emergency contraceptive methods and cause confusion. which may underpin larger anti-abortion strategies.
Kristi Hamrick, spokeswoman for Students for Life of America, said her organization Will “absolutely” consider suing Ella.
“The pro-life movement must be vindicated,” Ms. Hamrick said. “We’ve been arguing for years that Ella works as an abortion.”
Mary Ziegler, a law professor at the University of California, Davis and an abortion expert, said the study is both part of the abortion debate. May present challenges for parties.
“It’s going to add air to the clouds of abortion opponents who are saying that contraceptives can cause abortions,” she said, adding, “I think for abortion rights advocates It will be difficult to release this study.”
But Ms. Ziegler said the study’s findings could also be “politically dangerous” for abortion opponents because public support for contraception is high and many voters in conservative states support abortion rights protections. Ballot measures have been approved. “I think that’s one of the things that will prompt social conservatives to move perhaps faster than politics will allow right now to regulate contraception,” he said. “And I think that could backfire.”
Reproductive health experts said the new study did not refute the science showing that the morning-after pill did not cause miscarriages, because it involved a different dose of the drug.
Abortion opponents said they were not surprised by the study’s findings.
Dr. Donna Harrison, director of research for the American Association of Pro-Life, said, “After denying ulipristal acetate’s ability to end Bern’s life, abortion advocates now call it the abortion drug mifepristone. are starting to be used as an alternative to Obstetricians and Gynecologists said in a statement. “The reason is simple. Ulipristal and mifepristone work in the same way.
Ella was already a target for some conservatives. Project 2025a right-wing policy blueprint strongly aligned with the new Trump administration, said Ella should be removed from insurance coverage required for contraception under the Affordable Care Act because it is a “potential abortion.” .
Mifepristone, the first pill in the standard two-drug medication abortion procedure, 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. Another drug, misoprostol, is taken 24 to 48 hours later and causes contractions similar to an abortion.
Ulipristal acetate is in the same class of drugs as mifepristone and also blocks the activity of progesterone, a hormone that helps the uterus to receive and hold an embryo, said Dr. Daniel Grossman, a reproductive health physician and researcher at the University of California, San Francisco. prepares for San Francisco, which was not included in the new study.
In the study, a 60-milligram dose of alprastal acetate (double the 30-milligram dose in Ella) was substituted for mifepristone followed by misoprostol, which has different clinical uses and has not been targeted as much by abortion opponents. (Misoprostol can also facilitate abortion on its own, but is considered more effective in a combination regimen.)
Reproductive health experts said they welcome the search for an alternative to mifepristone as abortion opponents across the country step up efforts to restrict the drug, particularly with a federal lawsuit against the Food and Drug Administration. . The Supreme Court dismissed the suit last year, ruling that the original plaintiffs lacked standing to file the lawsuit, but the suit has since been reinstated by three states as plaintiffs.
Dr. Grossman, who wrote An editorial of the study, said that the possibility of a mifepristone alternative is “certainly a promising finding.” But, he added, “if the new evidence that ulipristal acetate can cause miscarriage at high doses leads to the withdrawal of ulipristal acetate from the market for emergency contraception, it That would be really, really bad.”
Perrigo, the company that makes Ella, which was approved by the FDA as an emergency contraceptive in 2010, released a statement saying that since new research has shown that Ella at doses higher than one pill Ulepristal acetate has been tested in combination with misoprostol, so “it’s ongoing. There’s no evidence to show that Ella by itself causes miscarriage.”
The study was conducted in Mexico City and was led by researchers there.
Several experts said that because this was a relatively small first study with no comparison of patients, more research was needed before Alpristil acetate could be used for abortion. “We cannot change clinical practice based on this study,” said Kelly Cleland, a researcher who is executive director of the American Society for Emergency Contraception.
Scientists have long understood that hormone-based drugs may be able to exert different effects at different doses along the spectrum of a woman’s reproductive health cycle.
In Europe, researchers including Dr. Rebecca Gomperts, a Dutch physician and founder of telemedicine organizations that provide abortion pills worldwide, are studying low doses of mifepristone as a weekly birth control pill. . Dr. Gomperts said he considered the new ulipristal acetate study sufficient to recommend the drug off-label for medical abortion.
“The more we use these drugs, the harder it is for people to get off them,” said Dr. Paul Blumenthal, an emeritus professor of obstetrics and gynecology at Stanford University who was on an advisory group for the study. were included.
Plan B is the most widely used morning-after pill in the United States, 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 inhibiting ovulation, the release of eggs from the ovaries that occurs before the eggs are fertilized, scientific studies show.
Some abortion opponents claim that morning-after pills are abortion pills based on the theory that they can also prevent a fertilized egg from implanting in the uterus. Most scientific research has not found this to be the case.
For years, despite scientific evidence to the contrary in a New York Times investigation, the FDA-approved label and packaging for Plan B One Step stated that when the pill works by blocking ovulation, there is a possibility was that it could prevent implantation. . In 2022, the agency changed the language to clarify that Plan B only works before fertilization, “will not work if you are already pregnant, and will not affect an existing pregnancy.”
gave FDA label Ella says its “probable primary mechanism of action” is to prevent or delay ovulation. The label also states that the drug may also affect implantation. Studies in recent years, however, Suggest that Ella does not work by preventing a fertilized egg from implanting. in the womb
