A retrospective cohort study «Fu L, Liu X, Tian Z, et al. Risk factors for methotrexate treatment failure in tubal ectopic pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2024;24(1):884. »4 included a total of 359 patients, with 268 (74.7%) succeeding with MTX and 91 (25.3%) required surgery. Specifically, 282 patients (78.6%) received 1-dose MTX, whereas 77 (21.4%) received 2-dose MTX. Gravidity, previous ectopic pregnancy, gestational age, pretreatment β-human chorionic gonadotropin (β-hCG) level, number of MTX treatments, and presence of a visible yolk sac in ultrasound were significant predictors. Higher gravidity (OR 1.25, 95% CI 1.01 to 1.54) and elevated pretreatment β-hCG levels (OR 1.00, 95% CI 1.0004 to 1.0008) were independent risk factors. Number of MTX treatments was a significant protective factor (OR 0.44, 95% CI 0.22 to 0.90).
A meta-analysis «Alur-Gupta S, Cooney LG, Senapati S, et al. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol 2019;221(2):95-108.e2. »5 included 7 RCTs with a total of 783 women. The 2-dose MTX protocol was associated with higher treatment success compared to the single-dose protocol (OR 1.84; 95% CI 1.13 to 3.00). The 2-dose protocol was more successful in women with high hCG (OR 3.23; 95% CI 1.53 to 6.84) and in women with a large adnexal mass (OR 2.93; 95% CI 1.23 to 6.9). The odds of side effects were higher in the 2-dose protocol.
Among 320 women in whom treatment was successful (91%) the mean serum chorionic gonadotropin concentration was 4 019 (SE 6 362), while it was 13 420 (SE 16 590) in those in whom the treatment was unsuccessful «Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med 1999 Dec 23;341(26):1974-8. »1.
A systematic review «Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril 2007;87(3):481-4. »2 included 5 observational studies with a total of 503 women using single-dose methotrexate stratified by initial hCG concentration. Failure rates increase with increasing hCG levels. A significant increase in failure rates was seen when comparing patients with initial hCG levels over 5 000 mIU/mL with those with initial levels under 5 000 mIU/mL (odds ratio 5.45; 95% CI 3.04 to 9.78). The failure rate with hCG between 5 000 and 9 999 mIU/mL was significantly higher than with hCG between 2 000 and 4 999 mIU/mL (odds ratio 3.76; 95% CI 1.16 to 12.33).
A clinical trial «Kim J, Jung YM, Lee DY et al. Pretreatment serum human chorionic gonadotropin cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregna»3 investigated pretreatment hCG cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. 53 women received a single-dose regimen and 32 women received a multi-dose regimen. Medical treatment failure was defined as necessity of surgical treatment. Treatment success rate was 64.2% in the single-dose group and 71.9% in the multi-dose group (P>0.05). Pretreatment serum hCG titer was an independent prognostic factor for treatment success in each regimen. Serum hCG cutoff value to predict the treatment success was 3 026 IU/L in single-dose regimen group and 3 711 IU/L in multi-dose regimen group.
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