Comparative study of low-dose versus standard single-dose methotrexate: A novel approach for medical treatment of ectopic pregnancy.

AIM: Methotrexate (MTX) treatment at a dose of 50 mg/m2 of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy.

METHODS

This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m2 of BSA (n = 17), 41-49 mg/m2 of BSA (n = 81) and ≥ 50 mg/m2 of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (β-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records.

RESULTS

Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pre-treatment β-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a β-hCG level of ≤5000 mIU/mL.

CONCLUSION

This study shows that lower MTX doses than 50 mg/m2 , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.