- 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.
- 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.
- Systematic review and meta-analysis of methotrexate treatment protocols.
- Randomized controlled trials (RCTs) included (7 studies).
- Primary outcome was treatment success.
- Funding: None disclosed.
- Limited by few RCTs available for analysis.
- Limited by limitations of original studies.