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Ectopic Pregnancy: Predicting Methotrexate Success.

PHILADELPHIA -- Serum level of human chorionic gonadotropin is the best predictor of whether systemic single-dose methotrexate will successfully treat tubal ectopic pregnancy Dr. Gary Lipscomb reported.

In a retrospective study of 350 consecutive ectopic pregnancies treated with single-dose methotrexate, serum HCG levels of 15,000 mIU/mL or greater were significantly associated with a marked increase in treatment failure rates, he said at the annual meeting of the American College of Obstetricians and Gynecologists.

"Until now there have been very few data on who is an ideal candidate for medical as opposed to surgical treatment," said Dr. Lipscomb, director of gynecology at the University of Tennessee, Memphis.

In the current study, maternal age, parity ectopic size, and mass volume were not significantly associated with treatment outcomes.

Serum HCG levels, initial serum progesterone, and ectopic cardiac activity were all significantly associated with treatment success when compared individually, according to the study, which was awarded first prize among papers on current investigations presented at the meeting.

However, serum HCG level was the only significant prognostic factor for treatment success when HCG, progesterone, and cardiac activity were compared together using logistic regression analysis.

Success rates dropped from a high of 98% with serum HCG levels of 0-1,000 mIU/mL to a low of 68% with serum levels of 15,000 mIU/mL or greater. (See box below.)

This finding is particularly important in women who have ectopic cardiac activity but low serum HCG levels.

"If you have someone who happens to have a 2,000 level of HCG, despite the fact that they have [ectopic] cardiac activity, they should still have a very good success level" with methotrexate, he told this newspaper.

"The reason that other people have reported that cardiac activity is associated with a high failure rate is that cardiac activity is almost always associated with high HCG levels. But if the HCG is low, that is the primary predictive factor," he said.

Dr. Lipscomb stressed that an HCG level that's at least 15,000 mIU/mL should not be an automatic contraindication to methotrexate treatment. Rather, the 68% success rate in these patients should be mentioned when helping women decide whether to use methotrexate.

Study participants received methotrexate at 50 mg per [m.sup.2] of body surface area; HCG levels were measured on days 1, 4, and 7.

Patients whose HCG levels had dropped more than 15% by day 7 were followed weekly until they reached an endpoint of 15 mIU/mL of HCG. Otherwise they were retreated with the same dose for a maximum of three doses.

             Methotrexate Treatment Success by Serum HCG Level

Success          Serum HCG Level
 Rate               (mIU/mL)
  98%                0-1,000
  93%              1,000-1,900
  92%              2,000-4,999
  87%              5,000-9,999
  82%             10,000-14,999
  68%   [greater than or equal to] 15,000

Source: Dr. Gary Lipscomb
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Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1U2PA
Date:Jul 1, 1999
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