Comparison of Single-dose and Multiple-dose Systemic Methotrexate Regimen for Ectopic Pregnancy / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: To compare the efficacy and side effects of single-dose and multiple-dose systemic methotrexate (MTX) regimen for ectopic pregnancies. METHODS: Between January 1999 and December 2002, 192 of 947 cases of ectopic pregnancies were treated with systemic methotrexate therapy at the Department of Obstetrics and Gynecology, Bundang CHA Hospital. The patients were treated with either of the two regimens a) Single dose regimen 50 mg/m2 of intramuscular MTX without leucovorin rescue (87 cases) b) Multiple dose regimen two to five doses of 1 mg/kg of IM MTX with leucovorin rescue (105 cases) Baseline characteristics, regimen used and the number of doses administered, treatment outcome, presence and severity of side effects were analyzed. Serum beta-hCG value at initiation of treatment and the presence of cardiac activity were controlled for with multivariate logistic regression. RESULTS: The mean age of the patients was 30.2 years (range 20-41) and gestational age at diagnosis was 45.8 days (range 28-70). Initial level of serum beta-hCG ranges from 1650 to 114332 mIU/ml (mean 3670.4). Non-tubal ectopic pregnancy occupied 23.4% of the study group. The multiple dose regimen was more commonly used. There were no significant differences in initial beta-hCG values, gestational age and presence of cardiac activity between single-dose arm and multiple-dose arm, between treatment success group and failure group. The overall success rate of MTX management for an ectopic pregnancy was 85.9% (165 of 192) with 79.3% and 91.4% for single and multiple dose regimen arms respectively. Side effects occurred in 22.9% (44 of 192) of the study group but no treatment was needed in most cases. CONCLUSION: Systemic methotrexate therapy is an effective and safe treatment modality for some selected ectopic pregnancies. Neither regimen showed definite superiority over the other. Further comparative studies with long-term follow-up are needed to evaluate reproductive outcome and to reduce side effects.