Single versus Multiple-doses of Methotrexate: A Retrospective Cohort Study to Compare the Efficacy and Observed Side Effects in Management of Ectopic Pregnancies

  • Zeinab Nazari
  • Hamed Jafarpour
  • Mohammad Tabarestani
  • Sara Sadr
  • Ahmadreza Shafizadeh
  • Fatemeh Shafizadeh
Keywords: Ectopic pregnancy, methotrexate, single-dose protocol, multiple-dose protocol

Abstract

Aim: In this study we aimed to compare the efficacy and observed side effects of the two used Methotrexate administration protocols in treatment of ectopic pregnancies. Methods: In this retrospective cohort study, 83 patients that met the inclusion criteria and were previously assigned to either the single-dose methotrexate regimen protocol (a single 50 mg/m2 intramuscular MTX injection) or the multiple-dose methotrexate protocol (1 mg/kg on the 1st, 3rd, 5th and 7th day of the treatment). Side effects and alterations in the human chorionic gonadotropin (β-HCG) levels on the 1st, 4th and 7th day after initiation of treatment were obtaines from patient case files. Results: Eighty three out of 98 patients that were treated with MTX met all the inclusion criteria. The average age of patients was 30.17 years, the mean gravida was 1.9 and the mean EP diameter was 36.63 mm. The hospitalization duration was shorter in the multiple-dose regimen group (3.85 days compared to 4.53 days). The endometrial thickness was higher in patients undergoing multiple-dose treatment (11.75 mm compared to 8.75). The prevalence of anemia, thrombocytopenia, leukopenia, raised liver enzymes and pain were not significantly different between the two groups (p>0.05). The treatment success rates were 78% and 85% for the single-dose regimen and the multiple-dose regimen, respectively (p>0.05). There was one reported case of fallopian tube rupture in the single-dose regimen group and two in the multiple-dose regimen group (p>0.05). Conclusion: Treatment success rates, the prevalence of side effects (Gastroenteritis, leukopenia, anemia, thrombocytopenia, bone marrow suppression) and alterations in β-HCG levels were not significantly different between the two treatment groups. We concluded that with fewer adverse effects and the same therapeutic benefits, a single-dose methotrexate regimen is preferable in a case of an unruptured EP with stable hemodynamics.

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Published
2019-03-25
Section
Original Research