A Novel Predict Factor That Increases the Success Rate of Methotrexate Treatment in Fallopian Tube Pregnancy

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2021 Feb 11

PMID 33569448

Citations 2

Authors

Qin Lin

Nan Lin

Gongli Wang

Xuan Zheng

Renyi Hua

Affiliations

Soon will be listed here.

Abstract

Background: For stable fallopian tube pregnancy (FTP), methotrexate (MTX) therapy is reported to be as effective as laparoscopy. However, some cases would need further treatment, e.g., another dose of MTX or laparoscopy. This study is to investigate the potential factors during the treatment of FTP that may facilitate the prediction of a successful outcome of MTX therapy.

Methods: All FTP cases admitted to the International Peace Maternal and Child Health Hospital (IPMCH), Shanghai, China from January 2016 to December 2017 were reviewed. All patients received a single dose of 50 mg/m MTX prior to other treatment. Statistical analysis was performed to determine the correlation between clinical parameters and the success rate of MTX treatment.

Results: The success rate of single-dose MTX was 77.53%. The serum beta-human chorionic gonadotropin (β-hCG) level cut-off value was 452.64 IU/L, with a specificity of 76.7% and sensitivity of 43% [area under the receiver operating characteristic curve (AUC) 0.803; P<0.0001]. In addition, serum β-hCG levels and patient age correlated with the success rate of MTX treatment.

Conclusions: Lower β-hCG levels led to successful MTX treatment for FTP, with a cutoff value of 452.64 IU/L. Younger patients were more sensitive to MTX treatment. These results may help clinicians when deciding the potential therapy for patients with tubal ectopic pregnancies.

Citing Articles

Do the change in β-hCG values between the 0th and 4th days in tubal ectopic pregnancy treatment with a single-dose methotrexate (MTX) protocol predict the need for a second dose of MTX?.

Akdas Reis Y, Akay A, Ozkan M, Firatligil F, Dereli M, Kinay T Arch Gynecol Obstet. 2023; 309(6):2585-2590.

PMID: 37493778 DOI: 10.1007/s00404-023-07116-3.

Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy.

Almutairy S, Aldakhil L J Pregnancy. 2022; 2022:5778321.

PMID: 36479045 PMC: 9722302. DOI: 10.1155/2022/5778321.

References

Ferreri A, Guerra E, Regazzi M, Pasini F, Ambrosetti A, Pivnik A . Area under the curve of methotrexate and creatinine clearance are outcome-determining factors in primary CNS lymphomas. Br J Cancer. 2004; 90(2):353-8. PMC: 2409565. DOI: 10.1038/sj.bjc.6601472. View

. The effect of age and renal function on the efficacy and toxicity of methotrexate in rheumatoid arthritis. Rheumatoid Arthritis Clinical Trial Archive Group. J Rheumatol. 1995; 22(2):218-23. View

Balci O, Ozdemir S, Mahmoud A, Acar A, Colakoglu M . The efficacy of multiple-dose methotrexate treatment for unruptured tubal ectopic pregnancy and conversion rate to surgery: a study on 294 cases. Fertil Steril. 2010; 93(7):2415-7. DOI: 10.1016/j.fertnstert.2009.09.014. View

Barnhart K, Gosman G, Ashby R, Sammel M . The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol. 2003; 101(4):778-84. DOI: 10.1016/s0029-7844(02)03158-7. View

Ustunyurt E, Duran M, Coskun E, Ustunyurt O, Simsek H . Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet. 2013; 288(5):1149-52. DOI: 10.1007/s00404-013-2879-8. View

Yang C, Cai J, Geng Y, Gao Y . Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: a systematic review and meta-analysis. Reprod Biomed Online. 2017; 34(4):383-391. DOI: 10.1016/j.rbmo.2017.01.004. View

Tanaka T, Hayashi H, KUTSUZAWA T, Fujimoto S, ICHINOE K . Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982; 37(6):851-2. DOI: 10.1016/s0015-0282(16)46349-1. View

Sowter M, Farquhar C, Petrie K, Gudex G . A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001; 108(2):192-203. DOI: 10.1111/j.1471-0528.2001.00038.x. View

Nama V, Manyonda I . Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet. 2008; 279(4):443-53. DOI: 10.1007/s00404-008-0731-3. View

10.

. Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21. BJOG. 2016; 123(13):e15-e55. DOI: 10.1111/1471-0528.14189. View

11.

Lipscomb G, McCORD M, Stovall T, Huff G, Portera S, Ling F . Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999; 341(26):1974-8. DOI: 10.1056/NEJM199912233412604. View

12.

Van Den Eeden S, Shan J, Bruce C, Glasser M . Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol. 2005; 105(5 Pt 1):1052-7. DOI: 10.1097/01.AOG.0000158860.26939.2d. View

13.

Helmy S, Bader Y, Pablik E, Tiringer D, Pils S, Laml T . Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014; 179:175-80. DOI: 10.1016/j.ejogrb.2014.05.033. View

14.

Mol B, Hajenius P, van der Veen F . Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 2000; 342(15):1138. DOI: 10.1056/nejm200004133421514. View

15.

Levin I, Tsafrir Z, Saar N, Lessing J, Avni A, Gamzu R . "Watchful waiting" in ectopic pregnancies: a balance between reduced success rates and less methotrexate. Fertil Steril. 2010; 95(3):1159-60. DOI: 10.1016/j.fertnstert.2010.10.014. View

16.

. ACOG Practice Bulletin No. 191 Summary: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018; 131(2):409-411. DOI: 10.1097/AOG.0000000000002499. View

17.

Helmy S, Koch M, Kolbl H, Grohmann-Izay B, Solomayer E, Bader Y . Correlation of the volume of ectopic pregnancy and MTX therapy outcome: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014; 184:108-11. DOI: 10.1016/j.ejogrb.2014.09.038. View