Abstract
Methotrexate was developed in 1949 as a synthetic folic acid analogue to compete with folic acid and thus interfere with cell replication. While initially developed as a potential treatment for acute lymphoblastic leukaemia, a serendipitous observation led to methotrexate's use to effect the dramatic cure of a case of advanced choriocarcinoma. This prompted the exploration for the potential of methotrexate to treat other conditions involving disordered trophoblastic tissue. Methotrexate has subsequently revolutionized the treatment of two pregnancy-related conditions—gestational trophoblastic neoplasia and ectopic pregnancy. This article reviews the development of modern treatment protocols that use methotrexate to medically treat these two important gynaecological conditions.
Highlights
Methotrexate is an antifolate drug which inhibits cell division by interfering with DNA replication [1]
Methotrexate is currently used in gynaecology to treat disorders arising from trophoblastic tissue, namely, ectopic pregnancy and gestational trophoblastic disease
Methotrexate has contributed to alleviating some of the disease burden of ectopic pregnancy, where it affords approximately 25% of women a nonsurgical and fertility-preserving treatment option [4]
Summary
Methotrexate is an antifolate drug which inhibits cell division by interfering with DNA replication [1]. Methotrexate is currently used in gynaecology to treat disorders arising from trophoblastic tissue, namely, ectopic pregnancy and gestational trophoblastic disease. Whilst the incidences of these conditions in pregnancy are relatively rare (ranging from 0.7% for GTD [2] to 1-2% for ectopic pregnancy [3]), their impact on the lives of young women of reproductive age, both in terms of mortality and morbidity (especially loss of reproductive potential), are significant. Methotrexate has contributed to alleviating some of the disease burden of ectopic pregnancy, where it affords approximately 25% of women a nonsurgical and fertility-preserving treatment option [4]. Methotrexate has dramatically improved survival outcomes in gestational trophoblastic neoplasia, where surgery is only occasionally used as an adjunct to treatment [5]. This article reviews methotrexate and its mechanism of action, gestational trophoblastic neoplasia and ectopic pregnancy, and how modern treatment protocols using methotrexate to medically treat these two conditions developed
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