Single-dose Methotrexate Treatment Research Articles

Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements.

The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels. Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve. A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient. Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.

Day 4 and day 0 neutrophil-to-lymphocyte ratios as predictors of treatment failure with single-dose methotrexate for ectopic pregnancies.

To evaluate changes in the neutrophil-to-lymphocyte ratio (NLR) between day 4 and day 0 in ectopic pregnancy (EP) patients treated with single-dose methotrexate (MTX) and investigate its predictive value for treatment outcome. A total of 406 EP patients receiving single-dose MTX therapy at Shanghai First Maternity and Infant Hospital from January 10, 2013 to September 30, 2019 were studied. A multivariate model was constructed to predict treatment outcome. Among the 406 patients, 281 were treated successfully. Treatment success declined significantly when NLR decreased by less than 23% (74.8% vs 58.5%, P = 0.004). Multivariate regression analysis identified NLR reduction of less than 23% on day 4 (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.27-3.44), a human chorionic gonadotropin (hCG) decrease of 15% or less (OR 3.17, 95% CI 1.62-6.34), and an hCG increase of more than 15% on day 4 (OR 5.47, 95% CI 3.05-10.22) as independent risk factors for single-dose MTX treatment failure. The final predictive model had a sensitivity of 0.768 and a specificity of 0.569, using a cut-off value of 3. The area under the receiver operating characteristic curve was 0.712. Patients with a predictive score of ≥3 were more likely to fail single-dose MTX therapy. The present study concluded that an NLR decrease of less than 23% on day 4, a plateau or increase in serum hCG on day 4, and an hCG value greater than 1000 mIU/mL on day 0 were predictors of single-dose MTX treatment failure in EP patients.

Predictive value of serum βHCG level in ectopic pregnancy: A cross sectional study.

Ectopic pregnancy (EP) is a potentially life-threatening emergency. We investigate the predictive value of serum βHCG level and it's changes from the baseline to the 4th and 7th days after single dose (SD) methotrexate (MTX) treatment in successful treatment of tubal EP. It is important for early diagnosis of EP. In this cross-sectional study, 690 women with tubal EP and under treatment with SD MTX were evaluated. Successful and failed groups were analyzed on the baseline, 4th and 7th days of MTX treatment. Data were analyzed using SPSS22 software. All p values of less than 0/05 were considered satistically significant. SD MTX treatment was successful in 584 (84.7%) patients. The mean baseline ßHCG value was 882.35 ± 430.76 in the successful group and 1083.99 ± 1080.25 in the failed group. There was a 19.53% decrease in ßHCG values between the baseline and 4th days in the successful group and a 12.94% increase in the failed group (p < 0.001). On days baseline, 4 and 7; receiver operating characteristic curve analysis's value was 504.5, 429, 279 for cut off; 58%, 73%, 81% for sensitivity and 51%, 52%, 55% for specificity, respectively. A decrease in the ßHCG value and/or a cut-off decrease of 59.9% on the baseline, 4th day and 81.6% between the baseline and 7th days, can predict the successful treatment of tubal EP with SD MTX.

The impact of maternal electrolyte and albumin levels on the efficacy of single-dose methotrexate treatment for ectopic pregnancies.

This study aims to investigate the impact of maternal albumin and serum electrolyte levels on the efficacy of single-dose methotrexate (SDMtx) therapy for ectopic pregnancies. Building on previous research, recommendations are provided to enhance the success of SD-Mtx therapy in the management of ectopic pregnancy. Conducted at a tertiary center gynecology clinic, the study included 353 patients diagnosed with ectopic pregnancy and treated with SD-Mtx from 2012 to 2023. Patients who responded positively to SD-Mtx treatment comprised Group 1 (n=313), while those requiring surgical intervention due to failed SD-Mtx therapy constituted Group 2 (n=40). Through the hospital's digital database, patient data including complete blood count, biochemistry, and hormone test results were retrospectively examined. The mean β-hCG value was 1996 IU/mL for Group 1 in contrast to 2058 IU/mL for Group 2. There was no statistically significant difference in β-hCG levels between the two groups. Notably, Group 1 patients exhibited lower serum magnesium levels but higher potassium levels compared to Group 2 patients, with statistically significant differences. Furthermore, Group 1 patients had higher albumin levels than those in Group 2, with a statistically significant difference. Successful SD-Mtx treatment was associated with lower maternal serum magnesium levels and higher potassium and albumin levels. Considering electrolyte levels before administering SD-Mtx and addressing any imbalances could potentially enhance treatment success. Additionally, restoring low albumin levels might improve the efficacy of SD-Mtx treatment for ectopic pregnancies. While this study suggests these trends, further extensive studies with a larger sample size are necessary to establish more definitive evidence.

The Retrospective Analysis of Factors Determining the Success of Single-Dose Methotrexate Treatment in Ectopic Pregnancy

Objective: We aimed to investigate treatment outcomes, treatment failure rates, factors causing failure, and complications of treatment in patients followed up with ectopic pregnancy and receiving methotrexate (MTX) treatment. Materials and methods: All ectopic pregnancies in a tertiary perinatology center who had single dose MTX between January 2015 and January 2021 were retrospectively included in this study. The demographic data of the women (age, gravida, parity, abortus numbers) and delivery [normal and cesarean sectio (C/S)] types were analyzed. The size of the mass, β-hCG level, presence of intra-abdominal free fluid and USG findings were recorded. The effectiveness of the treatment and the need for surgical treatment after MTX treatment were also investigated. Results: Overall, 93 ectopic pregnancies who had single dose MTX treatment were included in this study. The mean age was 30.4 years (SD ± 5.2). Previous ectopic pregnancy rate was 9.9% and 13.6% had free fluid in the abdomen. More than one third (35.8%) had undergone previous surgery and 8.6% had chronic disease. The median β-hCG level was 1763 mIU/ml (minimum 129 – maximum 67854, IQR 1010 - 2723 mIU/ml). The mean size of the mass was 9.3 mm (SD±6.1). A single dose of MTX treatment was found to be effective in 51.9%. β-hCG levels at the time of admission, mass size, patients age and pregnancy week were not effective on the success of single-dose MTX treatment. Conclusion: Single dose MTX therapy is used effectively and safely in the first treatment of ectopic pregnancy.

P-467 Early (day 1–4) post-treatment serum hCG level changes predict single-dose methotrexate treatment success in tubal ectopic pregnancy

Abstract Study question How effective is the change between day 1 and 4 post-treatment serum hCG level at predicting single-dose methotrexate treatment success in tubal ectopic pregnancy (tEP)? Summary answer Any fall in day 1–4 serum hCG signifies an 85% (95%CI 76.8–90.6) likelihood of treatment success for tEP managed with single-dose methotrexate. What is known already For those with tEP managed by single-dose methotrexate, current guidelines advocate intervention if day 4–7 hCG fails to fall by ≥ 15%. The trajectory of hCG over day 1–4 has been proposed as an early indicator that predicts treatment success, allowing early reassurance for women. However, almost all prior studies of day 1–4 hCG change have been small or retrospective. Study design, size, duration This was a prospective cohort study of women with tEP (pre-treatment hCG of ≥ 1000 IU/L and ≤5000 IU/L) managed with single-dose methotrexate. The data were derived from a UK multicentre randomised controlled trial of methotrexate and gefitinib versus methotrexate and placebo for treatment of tEP (GEM3). For this analysis, we include data from both treatment arms. Participants/materials, setting, methods Participants were categorised by single-dose methotrexate treatment success or failure. Treatment success for this analysis was defined as complete tEP resolution to serum hCG &amp;lt;30 IU/L following single-dose methotrexate treatment only. Patient characteristics between groups were compared. Changes in day 1–4, 1–7 and 4–7 serum hCG were evaluated as predictors of treatment success through receiver operating characteristic (ROC) curve analysis. Test performance characteristics were calculated for percentage reduction thresholds including optimal thresholds. Main results and the role of chance A total of 322 women with tEP and hCG ≥1000 IU/L and ≤5000 IU/L were treated with single-dose methotrexate. The overall single-dose methotrexate treatment success rate was 59% (n = 189/322). Day 1–4, 1–7 and 4–7 serum hCG change predicted single-dose methotrexate treatment success with ROC area under curve 0.80 (95% CI 0.74–0.85), 0.86 (95% CI 0.81–0.91) and 0.89 (95% CI 0.85–0.93) respectively. Any fall between day 1 and day 4 hCG predicted single-dose methotrexate treatment success with a positive predictive value of 85%, negative predictive value 57%, sensitivity 58%, specificity 84%, positive likelihood ratio 3.6 and negative likelihood ratio 0.5. A less than 18% rise in day 1–4 serum hCG was identified as an optimal classification threshold and predicted treatment success with 82% positive predictive value, 69% negative predictive value, 79% sensitivity, 74% specificity, positive likelihood ratio 3.0 and negative likelihood ratio 0.3. Limitations, reasons for caution Our findings may be limited by intervention bias resulting from existing guidelines which influences evaluation of hCG changes reliant on day 7 serum hCG levels. Wider implications of the findings This large prospective cohort demonstrates the value of day 1–4 serum hCG changes in predicting single-dose methotrexate treatment success in tEP. We recommend clinicians provide early reassurance to women who have fall or modest (&amp;lt;18%) rise in day 1–4 serum hCG that their treatment will likely be effective. Trial registration number This study is a secondary analysis of the GEM3 trial (ISRCTN Registry ISRCTN67795930).

The importance of β-hCG values in prediction of the effectiveness of single dose methotrexate therapy in tubal ectopic pregnancy.

To investigate the importance of β-hCG values on the day of onset and on the fourth and seventh day after treatment in the effectiveness of treatment in tubal ectopic pregnancies treated with a single dose of methotrexate (MTX). One hundred sixty-two patients with tubal ectopic pregnancy treated with a single dose MTX treatment were retrospectively evaluated. β-hCG values and changes on Days 0, 4 and 7 of the MTX treatment successful group and the unsuccessful group were analyzed. MTX treatment was successful in 125 (77.2%) and unsuccessful in 37. When the β-hCG values on Days 0, 4 and 7 were compared in pairs, the differences between groups were statistically significant (p < 0.001). The mean β-hCG value was 783.0 in the MTX successful group and 1802.0 in unsuccessful group (p < 0.001). There was a 21.6% decrease in β-hCG values between Days 0 and day 4 in the MTX successful group and a 25.7% increase in the MTX unsuccessful group (p < 0.001). On Days 0, 4 and 7, ROC curve analysis's values are , respectively; 755/939/486 for cut off, 86.49/83.78/94.59% for sensitivity and 48.80/69.60/72.36% for specificity. Success rates of single-dose MTX treatment increase in tubal ectopic pregnancies with low initial β-hCG value. Patients with a decrease in β-hCG value and/or a cut-off decrease of 20% or more on the fourth day of treatment can be called for weekly β-hCG monitoring without the need for close follow-up. The change in β-hCG between Day 0 and Day 4 can be used to predict the efficacy of treatment.

Management of ectopic pregnancy in a tertiary hospital: a retrospective cohort study.

The goal of this study was to manage the treatment modalities of ectopic pregnancy. This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (β-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (β-hCG) levels between the first and fourth day. There were significant differences between groups in terms of gestational age and β-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in β-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with β-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity. An increase in gestational age also leads to an increase in β-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes. This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG. The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together. The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

Early prediction of the failure of methotrexate treatment by Days 1–4 serum β-hCG change and 48-hour pre-treatment increment inβ-hCG

To determine whether the change of serum β-hCG levels between Days 1 and 4 and 48-h pre-treatment increment in β-hCG can early predict treatment failure of single-dose methotrexate (MTX) in tubal ectopic pregnancies (EP), a retrospective study of 1120 ectopic pregnancies treated with a regimen of a single dose of MTX was conducted in the Department of Obstetrics and Gynaecology, Shanghai First Maternity and Infant Hospital. Treatment failure was defined by an obligation to proceed to surgery or have an additional doses of methotrexate.1350 files were reviewed, with 1120 included for final analysis .64% (722/1120) had β-hCG levels increase on Day 4 after MTX treatment, while 36% (398/1120) had β-hCG levels fall. In this cohort, the treatment failure rate with a single dose of MTX was 15.7% (113/722), and the significant features in the logistic regression model of diagnosing the results of MTX treatment were the ratio of Day 1 to Day 48-h pre-treatment β-hCG values (Odds Ratio (OR) 1.221, 95% Confidence interval (CI) 1.159–1.294), the ratio of Day 4 to Day 1 β-hCG serum values (OR 1.098, 95% CI 1.014–1.226), and β-hCG values on Day 1 (OR 1.070, 95% CI 1.016–1.156). The decision tree model was developed by using increment of β-hCG in 48 h before treatment > =19%, the ratio of Day 4 to Day 1 β-hCG serum values > =36%, and β-hCG values on Day 1> =728 mIU/L to predict the failure of MTX treatment. The diagnostic accuracy, sensitivity and specificity in the test group were 97.22%, 100%, and 96.9%, respectively. IMPACT STATEMENT What is already known on this subject? A decrease of 15% β-hCG levels between Days 4 and 7 is a common protocol for predicting the success of a single-dose methotrexate therapy of an ectopic pregnancy. What do the results of this study add? This clinical study offers the cut-off values points for prediction of single-dose methotrexate treatment failure. What are the implications of these findings for clinical practice and/or further research? We identified the importance of β-hCG increase between Days 1 and 4 and β-hCG increment in 48 h pre-treatment for predicting the failure of single-dose methotrexate therapy. It can be used to aid the clinician to optimise the selection of the most appropriate treatment methods during a follow-up evaluation after MTX treatment.

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years' Experience in a Tertiary Center.

ObjectiveTo study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy.MethodsThis is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups.ResultsThe overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor.ConclusionThe single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.

The role of day 0 and day 4 β-human chorionic gonadotropin values and initial ultrasound findings in predicting the success of methotrexate treatment in ectopic pregnancy.

To determine the role of baseline ultrasound findings and the changes between β- human chorionic gonadotropin (hCG) values on day 0 to day 4 in patients receiving single-dose methotrexate (MTX) therapy for tubal ectopic pregnancy. One hundred fourteen patients who were hospitalized with a diagnosis of ectopic pregnancy and treated with single-dose methotrexate were included in this retrospective study. The successful treatment group (n = 88) comprised patients in whom serum β-hCG levels were resolved with single-dose methotrexate treatment, and the failed treatment group (n = 26) included patients who received second dose methotrexate and/or surgery. Ultrasound findings, laboratory findings, and serum β-hCG values at the time of admission and D4 and D7 β-hCG values were compared. The success rate of single-dose methotrexate treatment was 77.2%. In the successful treatment group, the initial β-hCG values of the patients were lower than the unsuccessful treatment group (1479.14 ± 1253.49, 4442.88 ± 3392.58, respectively) (p = 0.0001). A decrease of more than 35% between D0-D4 increased the probability of successful treatment (p = 0.017). Although ectopic focus size and abdominal free fluid showed no significant difference between the two groups, endometrial stripe thickness was significantly higher in the unsuccessful treatment group (12.61 ± 5.79, 9.28 ± 3.53) (p = 0.002). In addition to the basal β-hCG value, endometrial stripe thickness of ultrasound findings should also be considered in determining patients with a high chance of success in single-dose MTX treatment.β-hCG changes between D0-D4 may be advantageous in the clinical management of ectopic pregnancy for earlier evaluation.

Prognostic accuracy of a novel methotrexate protocol for the resolution of tubal ectopic pregnancies

ObjectiveTo evaluate if a decreasing human chorionic gonadotropin (hCG) between day (D) 1 and D7 is an equal or better predictor of tubal ectopic pregnancy (EP) resolution following methotrexate (MTX) treatment than the current standard of care. Study designThis was a retrospective cohort prognostic accuracy study of women with a transvaginal ultrasound (TVS)-confirmed tubal EP (November 2006–December 2015). After single-dose MTX treatment, D4/7 hCG ratios were compared with that of D1/D7 in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to predict EP resolution. ResultsTubal EP was diagnosed in 301/7350 (4.1%) women who underwent TVS for early pregnancy-related complaints. The patients were managed accordingly: expectant, 84/301 (27.9%); MTX, 65/301 (21.6%); surgery, 152/301 (50.5%). A D1/D7 hCG ratio ≤0.85 predicted successful resolution of tubal EPs (P < 0.001) treated with MTX with sensitivity 0.84 [95% confidence interval (CI), 0.69–0.94]), specificity 0.71 [95%CI, 0.48–0.89], PPV 0.84 [95%CI, 0.69–0.94], NPV 0.84 [95%CI, 0.69–0.94], which is comparable to the prognostic performance of the D4/7 protocol. ConclusionIn patients with tubal EP carefully selected for and treated with MTX, it may be reasonable to eliminate the D4 hCG in the follow-up algorithm.

Effect of Single-Dose Methotrexate Treatment on Ovarian Reserve in Women with Ectopic Pregnancy Undergoing Infertility Treatment: A Single-Center Experience.

BackgroundThe aim of this study was evaluation of the impact of single-dose methotrexate (MTX) treatment on ovarian reserve in women with ectopic pregnancy (EP) undergoing infertility treatment in Iranian population.Materials and MethodsThis prospective cohort study was done between March 2015 and March 2017 in Tehran General Women Hospital, Tehran, Iran. We enrolled 20 patients with EP who conceived during infertility treatment and received a single-dose MTX (50 mg/m2) intramuscularly. Serum anti-Mullerian hormone (AMH), 17 beta-estra diol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) on transvaginal ultrasonography, were evaluated before and 8 weeks after administration of MTX.ResultsAMH did not significantly vary after the administration of MTX, compared to before treatment value (P=0.36). FSH, E2 and AFC changes were not statistically significant, while increment of LH was significant (P=0.02).ConclusionResults indicated that single-dose MTX treatment did not reduce ovarian reserve in women with EP. Further randomized controlled clinical trial studies with larger sample sizes, by using multiple dosages of MTX, and with long-term follow up are suggested to be done.

1261 Risk Factors for Recurrent Ectopic Pregnancy Following Single-Dose Methotrexate Treatment

Study Objective We aimed to investigate the predisposing factors for recurrent ectopic pregnancy (REP) following single-dose methotrexate (MTX) treatment. Design A retrospective cohort study. Setting A tertiary medical center. Patients or Participants All patients diagnosed with a first EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions Cases (REP) and controls (first-time only EP) were compared in order to identify risk factors for REP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. Measurements and Main Results 272 women were included in the cohort of the study. Of those 22 (8.1%) had a REP. Women in the REP group had higher proportion of history of abortions (45.4% vs. 23.6%, p=0.02), higher rates of previous pelvic surgery and a history of both pelvic and uterine surgery (45.4% vs. 6.4%, 4.5% vs. 1.6%, respectively, p Conclusion Among women with EP, attention should be paid to women with previous pelvic surgery. Efforts should be made in order to achieve medical treatment success to prevent REP.

Risk factors for recurrent ectopic pregnancy following single-dose methotrexate treatment

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP.Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out.Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02).Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.

Tek doz metotreksat tedavisinde başarıyı etkileyen prognostik faktörlerin belirlenmesinde 3 yıllık analiz: Tek merkez deneyimi

Tek doz metotreksat tedavisinde başarıyı etkileyen prognostik faktörlerin belirlenmesinde 3 yıllık analiz: Tek merkez deneyimi

Predicting success of methotrexate treatment by pretreatment HCG level and 24-hour HCG increment.

To evaluate β-human chorionic gonadotropin (β-HCG) level and its 24-hour increment as predictors of successful methotrexate treatment for ectopic pregnancy. Data were retrospectively reviewed from women with ectopic pregnancy who were treated by single-dose methotrexate (50mg/m2 ) at a university hospital in Jerusalem, Israel, between January 1, 2000, and June 30, 2015. Serum β-HCG before treatment and its percentage increment in the 24hours before treatment were compared between treatment success and failure groups. Sixty-nine women were included in the study. Single-dose methotrexate treatment was successful for 44 (63.8%) women. Both mean β-HCG level and its 24-hour increment were lower for women with successful treatment than for those with failed treatment (respectively, 1224IU\L vs 2362IU\L, P=0.018; and 13.5% vs 29.6%, P=0.009). Receiver operator characteristic curve analysis yielded cutoff values of 1600IU\L and 14% increment with a positive predictive value of 75% and 82%, respectively, for treatment success. β-HCG level and its 24-hour increment were independent predictors of treatment outcome by logistic regression (both P<0.01). A β-HCG increment of less than 14% in the 24hours before single-dose methotrexate and serum β-HCG of less than 1600IU\L were found to be good predictors of treatment success.

Ektopik Gebelikte 0. ve 4. gün β-HCG Değerleri ile Metotreksat Tedavisinin Başarısı Öngörülebilir mi?

Aim: Ectopic pregnancy describes the pregnancies that develop outside the uterine cavity and composes about 2% of all pregnancies. It is responsible for approximately 10% of cases of maternal mortality (1). 97% of ectopic pregnancies are seen in the tuba (2). The classic, though non-pathognomonic, triad of the condition is delay of menstruation, vaginal bleeding, and unilateral pelvic pain. Medical treatment, surgical treatment, and expectant management can be applied. In recent years our success in diagnosing ectopic pregnancies earlier has led to widespread use of methotrexate treatment. In this retrospective study, we aimed to investigate our success rate in 71 ectopic pregnancy patients who underwent single-dose methotrexate (MTX) treatment, in connection with early period of β-HCG changes and their impact on the success of the treatment. Materials and Methods: In this retrospective study we evaluated 71 patients who had been diagnosed with ectopic pregnancy and treated with single-dose MTX treatment. We investigated the 0th, 4th, and 7th day β-HCG values of the patients. The groups in which the treatment had been successful and unsuccessful were compared in terms of age, previous ectopic pregnancy history, cigarette-smoking history, previous abdominal surgery history, and presence of pelvic mass, free liquid, and positive fetal cardiac activity during the diagnosis. The percentages of the patients whose 0th and 4th day β-HCG values showed an increase or decrease were determined in each group. In patients whose 4th day β-HCG values were seen to have increased, ΔHCG (the difference variable) was calculated as 4th day β-HCG value – 0th day β-HCG value and a comparison was made between the successful treatment and unsuccessful treatment groups. Results: The success rate of single-dose MTX treatment was found to be 66.2%. In the group in which MTX treatment was unsuccessful, 0th and 4th day β-HCG values were statistically significantly higher (p=0.018). The 4th day β-HCG values were detected to have increased in 38.7% of patients in the successful MTX treatment group and 35.3% of patients in the unsuccessful MTX treatment group. Although the average and median ΔHCG values were detected to be higher in the unsuccessful MTX treatment group, the difference was not statistically significant (p=0.58). Discussion and Conclusion : With respect to predicting the success of single-dose MTX treatment, high ΔHCG values, in addition to high basal β-HCG values, can also predict unsuccess in patients whose β-HCG values are observed to have increased on day 4.

Clinical predictors of failing one dose of methotrexate for ectopic pregnancy after in vitro fertilization.

The aim of this study is to investigate the clinical predictors of failure of a single dose of methotrexate (MTX) for management of ectopic pregnancy after in vitro fertilization (IVF). A retrospective cohort study was performed of women who conceived ectopic pregnancies following fresh or frozen IVF cycles at an academic infertility clinic between 2007 and 2014, and received intramuscular MTX (50mg/m2). Successful single-dose MTX treatment was defined as a serum beta-human chorionic gonadotropin (hCG) decline ≥15% between days 4 and 7 post-treatment. Logistic regression models adjusted for oocyte age, number of embryos transferred, and prior ectopic pregnancy were used to estimate the adjusted odds ratio (OR) (95% confidence interval [CI]) of failing one dose of MTX. Sixty-four patients with ectopic pregnancies after IVF were included. Forty required only one dose of MTX (62.5%), while 15 required additional MTX alone (up to four total doses, 23.4%), and 9 required surgery (14.1%). By multivariable logistic regression, the highest tertiles of serum hCG at peak (≥499IU/L, OR = 9.73, CI 1.88-50.25) and at first MTX administration (≥342IU/L, OR = 4.74, CI 1.11-20.26), fewer embryos transferred (OR = 0.37 per each additional embryo transferred, CI 0.19-0.74), and adnexal mass by ultrasound (OR = 3.65, CI 1.10-12.11) were each correlated with greater odds of requiring additional MTX and/or surgery. This is the first study to report that in women with ectopic pregnancies after IVF, higher hCG-though well below treatment failure thresholds previously described in spontaneous pregnancies-fewer embryos transferred, and adnexal masses are associated with greater odds of failing one dose of MTX. These findings can be used to counsel IVF patients regarding the likelihood of success with single-dose MTX.