Second dose methotrexate in ectopic pregnancies The role of beta human chorionic gonadotropin

Capsule:
Day-1 b-hCG should be used as a predictor for methotrexate treatment success, both in the first and the second injection of methotrexate.

Authors:
Aviad Cohen, M.D., Guy Bibi, M.D., Benny Almog, M.D., Ziv Tsafrir, M.D., Ishai Levin, M.D.

Volume 102, Issue 6, Pages 1646-1649

Abstract:

Objective:
To evaluate the role of β-hCG levels on days 1, 4, and 7 after methotrexate as predictors for second-dose requirement and success.

Design:
Retrospective cohort study.

Setting:
Tertiary university-affiliated hospital.

Patient(s):
A total of 1,703 patients were admitted because of ectopic pregnancy. Four hundred nine received methotrexate, of whom 73 women required a second dose.

Intervention(s):
The “single-dose” methotrexate protocol with 50 mg/m2 was administered to patients with progressing ectopic pregnancy. Surgical intervention was performed in cases of methotrexate second-dose treatment failure.

Main Outcome Measure(s):
Methotrexate second-dose requirement and success according to β-hCG levels on days 1, 4 and 7.

Result(s):
Second-dose methotrexate was successful in 58 patients (79.4%, success group), whereas 15 patients (20.6%) failed treatment and required surgical intervention (failure group). The medians of β-hCG levels on days 1, 4, and 7 were significantly higher in the “failure group” (1,601 vs. 2,844, 2,164 vs. 3,225, and 1,915 vs. 3,745 mIU/mL, respectively). Logistic regression analysis demonstrated that day-1 β-hCG levels were the only significant independent variable for second-dose treatment outcome. The receiver operating characteristic curve for β-hCG levels on day 1 was 0.727, and at a cutoff value of 2,234 mIU/mL the sensitivity and specificity reached the optimum for treatment success (77.5% and 73.3%, respectively).

Conclusion(s):
Day-1 β-hCG levels were the only predictors for methotrexate second-dose requirement and treatment success. The cutoff value of β-hCG on day 1 with the optimal treatment results was found to be 2,234 mIU/mL.

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