Two-Dose Versus Single-Dose Methotrexate for Treatment of Ectopic Pregnancy: A Meta-analysis

摘要

A number of studies have demonstrated comparable efficacy of medical and surgical management for treatment of stable ectopic pregnancies. Methotrexate, a folate antagonist, has been the mainstay of medical management. The 3 most widely used methotrexate protocols are single-dose, 2-dose, and multidose protocols. Although the multidose protocol is beneficial for patients at higher risk of failing medical management, the increased frequency of administration requires the addition of folinic acid rescue, alternating with methotrexate doses, to reduce adverse effects. Introduction of a single-dose protocol decreases the number of visits, but requires additional treatment and follow-up in many patients. The 2-dose protocol was introduced in an attempt to achieve a balance between the benefits of increased treatment success from the multidose regimen with use of the same convenient visit schedule as the single-dose protocol. With methotrexate, success rates for ectopic pregnancy (EP) management range from 70% to 90% for the single-dose, 80% to 90% for the 2-dose, and 89% to 96% for the multidose protocols. A number of studies attempting to compare one protocol to another have been limited by their retrospective nature, use of nonstandard protocols, and heterogeneous outcome definitions.