Success rate of methotrexate treatment for recurrent vs. primary ectopic pregnancy: a case-control study

• Published in: Journal of obstetrics and gynaecology Vol. 40; no. 4; p. 507
• Main Authors: Levin, Gabriel, Dior, Uri P, Shushan, Asher, Gilad, Ronit, Benshushan, Avi, Rottenstreich, Amihai
• Format: Journal Article
• Language: English
• Published: England 18.05.2020
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortifacient Agents, Nonsteroidal - adverse effects; Adult; Case-Control Studies; Chorionic Gonadotropin - blood; Drug Dosage Calculations; Drug Monitoring - methods; Female; Humans; Israel - epidemiology; Methotrexate - administration & dosage; Methotrexate - adverse effects; Pregnancy; Pregnancy, Tubal - blood; Pregnancy, Tubal - diagnosis; Pregnancy, Tubal - drug therapy; Pregnancy, Tubal - epidemiology; Recurrence; Risk Factors; Treatment Outcome; Israel; recurrent ectopic pregnancy; Ectopic pregnancy; methotrexate
• ISSN: 1364-6893
• DOI: 10.1080/01443615.2019.1621819

The aim of this study was to compare the success rate of methotrexate (MTX) treatment in patients with recurrent ectopic pregnancy (REP) and primary EP (PEP). A retrospective cohort study. The study cohort comprised all patients diagnosed with an EP and treated by intention with single-dose regimen of intramuscular MTX in a tertiary medical centre during 2010-2018. Cases (REP) and controls (PEP) were compared.262 patients had PEP and 32 had a REP. Women with REP had significantly higher gravidity order and higher incidence of previous abortions (5 3, median,  < .001, 59.3% 32.8%,  < .001, respectively). Women with REP had a higher proportion of a history of previous surgery in general, and specifically pelvic surgery (46.8% 20.6%,  < .001, 24.4% 7.2%,  < .001, respectively). Treatment success was lower in the REP group (40.6% 66.4%,  = .006, Odds ratio 0.34, 95% confidence interval 0.16, 0.73). In a logistic regression analysis, the only factor found to be independently associated with treatment failure was REP (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.77,  = .01). Our study suggests that medical treatment success with a single-dose regimen of MTX is lower than expected among REP cases, suggesting that different treatment approach should be considered in this setting.Impact statement There is paucity of data regarding success rate of methotrexate treatment for a recurrent ectopic pregnancy (REP). Medical treatment success with a single-dose regimen of MTX in patients with a REP is lower than expected As medical treatment success with a single-dose regimen of MTX for women with a REP is lower than expected, different treatment approach should be considered. Further and prospective studies with a larger sample size are needed to confirm our findings.