1225 Early Prediction of Methotrexate Treatment Success by 24‐Hour Pretreatment HCG Increment and Day 1-4 HCG Ratio

Abstract

Study Objective Several studies have tried to identify early markers for treatment outcome after methotrexate (MTX) treatment for an ectopic pregnancy (EP) including pretreatment and day 4 hCG levels and corresponding ratio, and hCG increment during the initial 24 hours following treatment, with conflicting results. We aim to re‐evaluate the role the aforementioned markers in the earlier identification of treatment success in a large cohort of women. Design A retrospective cohort study. Setting A tertiary medical center during 2010-2018. Patients or Participants All women diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions A comparison of maternal and gestation characteristics was performed between treatment success and failure groups. Measurements and Main Results 292 women treated with single-dose intramuscular MTX for EP during were included in this study. Treatment success rate with a single dose of MTX of the overall cohort was 62.7% (183/292). Only two independent determinants were significantly associated with the treatment success: initial 24 hours hCG percentage of increment (adjusted odds ratio [OR]: 1.82; 95% confidence intervals [CI]: 1.26, 2.63; p Conclusion A low rise in hCG levels 24 hours prior to treatment with MTX, alongside a decline in hCG levels from day 1 to day 4 may predict success of medical treatment of EP.