2-drug abortions set for test here Planned Parenthood is to begin trials at city clinic next year

Planned Parenthood clinics will soon make nonsurgical abortions available to 3,000 women, including some in Maryland, through a nationwide trial that will use two drugs widely employed to battle cancer and prevent ulcers.

The trial will begin by fall in some areas. Planned Parenthood of Maryland plans to start offering the service shortly after the New Year at its Howard Street headquarters and, possibly, at some of its six satellite centers.


"We don't know what the demand will be because it's new, but what's crucial is that this is a new choice for women," said Sana F. Shtasel, president and chief executive officer of Planned Parenthood of Maryland.

Some physicians have already been using the drugs, methotrexate and misoprostol, to end unwanted pregnancies -- a legal practice because the medications have long been approved for other medical uses.


Abortion opponents have steadfastly condemned medical as well as surgical methods, most of which employ suction to expel a fetus.

"Methotrexate may cause serious complications for the mother and stops the beating heart of her unborn child," Sid Marcus, president of Maryland Right to Life, said yesterday.

Planned Parenthood has refrained from using the drugs to end pregnancies until the method underwent federally approved testing.

The Food and Drug Administration quietly approved the trials last month.

In announcing the trials yesterday, officials with the family planning centers said they wanted to submit the technique to scientific scrutiny -- but predicted the study would show it to be a safe and effective way to induce miscarriage in the first seven weeks of pregnancy.

Such a result, they said, could prompt the FDA to approve a change in the drugs' labeling.

Shtasel said the trial, along with the FDA's expected approval of the French abortion pill RU-486, opens a new era for women wanting greater choice in terminating a pregnancy.

Some abortion rights advocates predict the government's approval of RU-486 is imminent, although the FDA has not announced a timetable.


Methotrexate has been used for 20 years to treat certain cancers as well as adult rheumatoid arthritis and psoriasis. More recently, it has been used to end ectopic pregnancies -- life-threatening pregnancies that occur outside the uterus.

It induces abortion by halting fetal cell division, and thus the development of the embryo.

The second drug, misoprostol, is commonly used to prevent stomach ulcers in people who take large quantities of anti-inflammatory drugs such as ibuprofen. In a nonsurgical abortion, it causes the uterus to contract and expel the aborted embryo.

In the Planned Parenthood trials, women would receive a single injection of methotrexate. Then, five to seven days later, four misoprostol pills would be inserted into the vagina to complete the process. Both stages would be done at the family-planning clinic and under a doctor's care.

Much smaller studies have shown the two-drug combination to be 90 percent effective in ending a pregnancy. Side effects include nausea, diarrhea, abdominal cramping and vaginal bleeding.

Dr. Paul Blumenthal, medical director of the Maryland affiliate, said the side effects were extremely uncommon in the doses used to induce an abortion.


The problems are more commonly associated with the long-term use required, for instance, in cancer treatments.

"I think that for the indications that intend to use them, we are going to find that they are safe," Blumenthal said.

While 90 percent of all abortions occur in the first trimester of pregnancy, more than half of those take place after the first seven weeks -- the window of time in which RU-486 and the two-drug combination are used.

Blumenthal, however, said there is a trend toward earlier abortions, motivated in part by the availability of home and laboratory tests that are capable of diagnosing pregnancies much earlier than before.

"When the availability of these medications becomes knowledge on the street, this may result in a sort of change in behavior."

It remains to be seen whether patients would prefer RU-486, known chemically as mifepristone, or the two drugs to be tested by Planned Parenthood.


Some, he said, may prefer the methotrexate-misoprostol combination because the drugs are more familiar to Americans, having been used for many years to treat other illnesses. But RU-486 is taken orally and may be favored by people who don't like injections.

Although the Planned Parenthood study is the first one involving large numbers of patients, the smaller studies showed their safety and effectiveness to "in the same ballpark" as RU-486's, Blumenthal said.

Pub Date: 9/12/96