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Efficacy of methotrexate

      To the Editors:

      I was pleased to read the article by Stika et al. (Stika CS, Anderson L, Frederikson MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern Memorial Hospital three-year experience. Am J Obstet Gynecol 1996;174:1840-8.) The results of Stika et al. showing only a 64% success rate of resolution of ectopic pregnancy with a single methotrexate injection contrasts with the 85% to 95% success rates of other authors.
      In fact, there are few reports showing limited success with methotrexate. In our study
      • Shalev L
      • Peleg D
      • Bustan M
      • Romano S
      • Tsabari A
      Limited role of intratubal methotrexate treatment of ectopic pregnancy.
      50 mg of methotrexate was injected directly into a laparoscopically confirmed ectopic pregnancy. Of 44 patients treated this way, only 27 (61.4%) had successful resolution and 17 (38.6%) required a further procedure, usually salpingostomy or salpingectomy.
      Treatment for ectopic pregnancy by methotrexate requires the patient to be under prolonged observation, with failure occurring up to several weeks after the injection, even in the face of decreasing β-human chorionic gonadotropin levels. These patients must be carefully selected and counseled. It is probable that when other centers review their results with single-dose methotrexate, they will find a success rate below the classically reported 97% reported by Stovall and Ling.
      • Stovall TG
      • Ling FW
      Single-dose methotrexate: an expanded clinical trial.

      References

        • Shalev L
        • Peleg D
        • Bustan M
        • Romano S
        • Tsabari A
        Limited role of intratubal methotrexate treatment of ectopic pregnancy.
        Fertil Steril. 1995; 63: 20-24
        • Stovall TG
        • Ling FW
        Single-dose methotrexate: an expanded clinical trial.
        Am J Obstet Gynecol. 1993; 168: 1759-1765