Management of patients receiving long-term treatment with mifepristone

Objective: To determine clinical side effects and biochemical and hematological abnormalities in patients with nonresectable meningioma on long-term mifepristone (RU 486) therapy. Design: Long-term mifepristone administration in patients with meningioma. Setting: Outpatient clinic of a university hospital, Patient(s): Sixteen women and 9 men aged 22-80 years with nonresectable meningioma. Intervention(s): Mifepristone (200 mg daily). One patient received treatment for more than 13 years; six received treatment for 10-12 years; five received treatment for 4-9 years; eight received treatment for 1-4 years; and the remainder received treatment for 4-10 months. Main Outcome Measure(s): Evaluation of side effects and of hematological and biochemical abnormalities. Result(s): Fatigue was observed in 22 of 25 patients. Endometrial hyperplasia occurred in one premenopausal woman and one postmenopausal woman. Another two women had endometrial thickening without hyperplasia. There were no consistent abnormalities in liver or renal function or in any other biochemical or hematological parameters. One subject (on long-term dexamethasone) developed hypoadrenalism, which responded to treatment. Conclusion(s): Mifepristone can be administered for prolonged periods. Ultrasound should be performed if irregular vaginal bleeding, occurs. In asymptomatic women, it should be performed annually. If endometrial thickening is observed, then endometrial biopsy is recommended. Because biochemical hypothyroidism has been reported during long-term mifepristone therapy, thyroid function tests should be performed annually.