Early prediction of the success of methotrexate treatment success by 24–hour pretreatment increment in HCG and day 1–4 change in HCG

Dior, Uri; Shushan, Asher; Gilad, Ronit; Benshushan, Abraham; Rottenstreich, Amihai

doi:10.1016/j.rbmo.2019.02.005

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…Second, the study cohort is relatively small (n = 121) for current literature. This might explain why the authors have found that early β-hCG kinetics does not adequately predict treatment outcome and that initial serum β-hCG measurement was the only significant prognostic factor for MTX efficacy-this in contrast to recent literature that early β-hCG kinetics is indeed an early determinant of treatment success but the β-hCG level itself on day 1 is of no predictive value [4]. At Last, if an early predictors are on the spotlight, it should be acknowledged that earlier predictors have been studied and found to be predictive for MTX treatment success such as pretreatment β-hCG kinetics [4,5].…”

Section: Dear Editorsmentioning

confidence: 69%

Earlier predictors for treatment outcome among single dose methotrexate for an ectopic pregnancy

Rottenstreich

2019

Arch Gynecol Obstet

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Section: Dear Editorsmentioning

confidence: 69%

Earlier predictors for treatment outcome among single dose methotrexate for an ectopic pregnancy

Rottenstreich

2019

Arch Gynecol Obstet

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“…Agostini et al [ 20 ] found that a cutoff level of a 20% decrease in HCG levels between days 1 and 4 predicted the success rate with 97% sensitivity. Ustunyurt et al [ 11 ] and Levin Gabriel et al [ 21 ] proposed that a > 22% decrease in β-hCG levels between days 1 and 4 is the best predictor of the treatment success of a single-dose regimen. Girija S. et al [ 22 ] reported a cutoff value of a 10% decrease in β-hCG levels between days 1 and 4 to predict the treatment success rate with a sensitivity of 77% and a specificity of 81%.…”

Section: Discussionmentioning

confidence: 99%

Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

Zhang

Gan

Liu

et al. 2020

BMC Pregnancy Childbirth

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Background Ectopic pregnancy is a major life- and fertility-threatening women’s health concern. As a result of advances in examination technology, an increasing number of ectopic pregnancies can be diagnosed early and treated with medical methods instead of surgery. The aim of this study was to summarize the clinical features and identify the predictors of success of methotrexate (MTX) treatment of ectopic pregnancy. Methods This was a retrospective study of 238 ectopic pregnancies treated with MTX in the Department of Gynecology of Shaanxi Provincial People’s Hospital from January 2017 to December 2017. Results Patients were divided into two groups: the successful treatment group (n = 166) and the failed treatment group (n = 72). The overall success rate of MTX therapy for ectopic pregnancy was 69.75%. The mean initial beta-human chorionic gonadotropin (β-hCG) level was significantly lower in the successful treatment group than in the failed treatment group (2538.08 IU/L versus 3533.17 IU/L, P = 0.000). The treatment success rate of the group with an initial β-hCG concentration less than 4000 IU/L was significantly higher than that of the group with an initial β-hCG concentration greater than 4000 IU/L. However, the success rate of the group with an initial β-hCG concentration greater than 4000 IU/L was still relatively high (54.55%). β-hCG levels were significantly increased on the 4th day in the failed treatment group (P = 0.000). Compared to the initial β-hCG level, the day-4 β-hCG level increased by more than 8.21%, indicating that the treatment was effective. The diagnostic sensitivity was 88.6%, the specificity was 74.5%, and the area under the receiver operating characteristic (ROC) curve was 0.863 (95% confidence interval (CI): 0.805–0.920). Conclusions MTX therapy as a treatment option is safe and effective for asymptomatic, hemodynamically stable patients with ectopic pregnancies who are interested in conservative treatment, regardless of the serum β-hCG level or adnexal mass size. The change in the β-hCG level between the initial day and the 4th day is an effective and early predictive tool for the success of MTX therapy for ectopic pregnancy.

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“…We evaluated response to medical treatment, needing second dose or the failure of medical therapy and the need for surgical management were evaluated in all included patients. We followed patients who were responding to medical therapy whether the first or second dose weekly until achieving β-hCG target level (<15 mIU/mL) then completely negative values [1,5,9]. Failure of medical therapy by methotrexate is denoted by occurrence of persistent or increasing pelvic pain, an increasing the adnexal mass size using trans-vaginal ultrasound or suboptimal reduction in hCG levels [4].…”

Section: Inclusion Criteriamentioning

confidence: 99%

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

Lashin

Alabiad

Abdelsalam

2020

Zagazig University Medical Journal

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Background: Using Methotrexate as an option for medical treatment of ectopic pregnancies has been suggested since 1982. Studies regarding the dose, number of doses of methotrexate and the predictive factors of degree of success of methotrexate in the medical management of ectopic pregnancy are limited. Aim of the present article were; to assess the predictive factors of success and efficacy of methotrexate therapy and to assess the value and efficacy of using lower dose of methotrexate and the suitable number of doses for medical management of ectopic pregnancy. Methods: we included 100 patients with ectopic tubal pregnancy that were given Methotrexate dosage 1 mg/kg which was injected intramuscular. After the first injection we asked the patients to return on the 4 th day then on the 7 th day to test the levels of hCG. In case of reduction of the level of β-hCG less than 15% on 4 th and 7 th days, patients were given the second methotrexate dose of 1 mg/kg which was also injected intramuscular. We followed patients until achieving β-hCG target level (<15 mIU/mL) then completely negative values. We assessed rates and predictive factors for success or failure of methotrexate therapy. Results: of the included 100 patients, 15 patients needed surgical management at the end of treatment, with a success rate of medical Methotrexate therapy of 85%.The pretreatment predictive factors of failure of medical treatment are; presence of a pretreatment adnexal mass (p= 0.040), presence of pain (p= 0.039), metrorrhagia (p= 0.023), or hemoperitoneum (p= 0.002). Base line pretreatment hCG levels was the most important predictive factor of therapy success (p= 0.002). Conclusions: methotrexate in a single dose or two doses could effectively treat ectopic pregnancy with fewer side effects providing that base line hCG level < 5000 IU/L in hemodynamically stable young patients with no liver or kidney problems with a higher success rate.

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Early prediction of the success of methotrexate treatment success by 24–hour pretreatment increment in HCG and day 1–4 change in HCG

Cited by 21 publications

References 24 publications

Earlier predictors for treatment outcome among single dose methotrexate for an ectopic pregnancy

Earlier predictors for treatment outcome among single dose methotrexate for an ectopic pregnancy

Predictors and clinical features of methotrexate (MTX) therapy for ectopic pregnancy

Values and predictive factors for Success of Methotrexate Therapy in Medical Management of Ectopic Pregnancy

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