Methotrexate Success Varies in Ectopic Pregnancy Types

TOPLINE:

Overall success rates for intramuscular (IM) methotrexate were comparable between recurrent and primary ectopic pregnancy cases, but single-dose treatment was less effective in recurrent cases. Analysis of 3944 patients revealed that multidose regimens achieved similar success rates in both groups, suggesting a potential benefit of routine multidose treatment for recurrent cases.

METHODOLOGY:

• Researchers conducted systematic searches of MEDLINE, EMBASE, and Scopus databases through February 2025, following PRISMA guidelines for meta-analysis.
• Analysis included 3944 patients (502 with recurrent and 3442 with primary ectopic pregnancy) from 15 observational studies, with patients aged ≥ 18 years receiving IM methotrexate treatment.
• The primary outcome measure was treatment success, defined as complete resolution of ectopic pregnancy without requiring further intervention.

TAKEAWAY:

• Single-dose IM methotrexate had lower success rates in patients with recurrent ectopic pregnancy than in those with a primary ectopic pregnancy (relative risk [RR], 0.79; 95% CI, 0.63-1.00; P = .050).
• Multidose IM methotrexate treatment showed no significant difference in success rates between recurrent and primary ectopic pregnancy groups (RR, 1.14; 95% CI, 0.71-1.84; P = .590).
• Substantial heterogeneity was observed among studies analyzing single-dose (I² = 73.0%) and multidose (I² = 64.0%) treatment outcomes.

IN PRACTICE:

“Current observational data suggest that patients with recurrent ectopic pregnancy should be considered for multidose IM methotrexate to achieve similar rates of success compared with primary ectopic pregnancy,” wrote the authors of the study.

SOURCE:

The study was led by Shreya Bhat, MBChB, PGDipOMG, Department of Obstetrics and Gynaecology, Palmerston North Hospital, Te Whatu Ora MidCentral in Palmerston North, Aotearoa New Zealand. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

According to the authors, substantial heterogeneity in outcome definitions and baseline cohort characteristics between studies affected the analysis. Most studies were retrospective cohort designs, introducing potential selection bias and confounding factors. The researchers noted that over 50% of studies failed to identify relevant confounding variables, which likely contributed to the large observed CIs for effect estimates.

DISCLOSURES:

The authors did not report any potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.