Ectopic pregnancy: does dosing of methotrexate matter?

  • Am J Obstet Gynecol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • First-line medical therapy for ectopic pregnancy should include 2 doses of methotrexate.

Why this matters

  • Ectopic pregnancy is a potentially life-threatening condition that occurs in 2% of pregnancies.
  • Earlier detection allows medical management of ectopic pregnancy.

Key results

  • 2-dose regimens were associated with 1.84 times the odds of achieving treatment success (4 studies, 95% CI, 1.13-3.00) compared with a single dose.
  • Side effects were 1.53 times higher in the 2-dose regimen compared with the 1-dose regimen (4 studies, 95% CI, 1.01-2.30); most were mild and transient.
  • Follow-up was 7.9 days shorter in the 2-dose regimen compared with the 1-dose regimen (95% CI, −12.2 to −3.5).
  • No significant difference in multidose vs single-dose regimens.

Study design

  • Systematic review and meta-analysis of methotrexate treatment protocols.
  • Randomized controlled trials (RCTs) included (7 studies).
  • Primary outcome was treatment success.
  • Funding: None disclosed.

Limitations

  • Limited by few RCTs available for analysis.
  • Limited by limitations of original studies.

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