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Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 795–795 | Cite as

Early predictive factors of single dose methotrexate outcome in patients with ectopic pregnancy

  • Jérémy Brunello
  • Paul Guerby
  • Chloé Cartoux
  • Alexandre Yazigi
  • Martin Baujat
  • Olivier Parant
  • Christophe Vayssière
  • Elodie Chantalat
  • Fabien VidalEmail author
Correspondence
  • 205 Downloads

Dear editor,

We read with great interest the comment of Levin et al. regarding our article recently published in Archives of Gynecology and Obstetrics [1]. In their letter, the authors suggest that the dosage we used for single dose methotrexate (MTX) therapy (1 mg/kg, versus 50 mg/m2 of body surface area in the protocol by Stowall et al. [2]) may explain the relatively low success rate we observed (54.5% following a single injection). However, high-quality data comparing the efficacy of single dose MTX treatment according to MTX dosage are still lacking. Hence, recent French guidelines have recommended the use of both dosages [3].

In a recent retrospective study, Levin et al. tried to identify early markers of single dose MTX success. The authors concluded that the initial 24 h increase in βhCG and the percentage change in βhCG from day 1 to day 4 were significant prognostic factors for treatment outcome [4]. Nevertheless, their true performances in predicting treatment success were quite low. Indeed, βhCG change between day 1 and day 4 displayed an area under curve (AUC) of 0.66. In contrast, AUC was 0.826 in our study. Furthermore, it is unclear whether baseline βhCG level was included in their logistic regression model while it has been identified as a strong prognosis factor in many studies [1, 5].

We agree that identification of earlier predictors of single dose MTX success is of tremendous importance. However, their implementation in routine practice is probably even more important. To date, available literature does not support the use of early βhCG kinetics to plan post-treatment follow-up, except for patients displaying extreme changes. Further, larger and prospective studies are thus required to fully determine the clinical usefulness of such parameters.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Brunello J, Guerby P, Cartoux C, Yazigi A, Baujat M, Parant O et al (2019) Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy? Arch Gynecol Obstet 299(3):741–745CrossRefGoogle Scholar
  2. 2.
    Stovall TG, Ling FW, Gray LA (1991) Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 77(5):754–757Google Scholar
  3. 3.
    Marret H, Fauconnier A, Dubernard G, Misme H, Lagarce L, Lesavre M et al (2016) Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF. Eur J Obstet Gynecol Reprod Biol 205:105–109CrossRefGoogle Scholar
  4. 4.
    Levin G, Dior U, Shushan A, Gilad R, Benshushan A, Rottenstreich A (2019) Early prediction of methotrexate treatment success by 24-hour pretreatment hCG increment and day 1–4 hCG ratio. Reproductive Bio Med Online.  https://doi.org/10.1016/j.rbmo.2019.02.005 Google Scholar
  5. 5.
    Cohen A, Zakar L, Gil Y, Amer-Alshiek J, Bibi G, Almog B et al (2014) Methotrexate success rates in progressing ectopic pregnancies: a reappraisal. Am J Obstet Gynecol. 211(2):128.e1–5CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jérémy Brunello
    • 1
  • Paul Guerby
    • 1
    • 2
  • Chloé Cartoux
    • 3
  • Alexandre Yazigi
    • 1
  • Martin Baujat
    • 1
  • Olivier Parant
    • 1
    • 2
    • 4
  • Christophe Vayssière
    • 1
    • 2
    • 4
  • Elodie Chantalat
    • 2
    • 5
  • Fabien Vidal
    • 1
    • 2
    Email author
  1. 1.CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de ViguierToulouseFrance
  2. 2.Université de Toulouse III, UMR1027ToulouseFrance
  3. 3.Department of Obstetrics and GynecologyCHU Saint-PierreGaillonFrance
  4. 4.Inserm, UMR1027ToulouseFrance
  5. 5.CHU Toulouse, Service de Chirurgie GynécologiqueToulouseFrance

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