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Methotrexate Efficacy Diminished in Serial Ectopic Pregnancies: Presented at ACOG

By Bruce Sylvester

NEW ORLEANS, LA, -- April 29, 2003 -- Prior ectopic pregnancy appears to be an independent risk factor for failure of treatment with methotrexate in subsequent ectopic pregnancies, researchers reported.

"We wanted to look at two things," said presenter and lead investigator Gary Lipscomb, MD, assistant professor in the department of gynecology, University of Tennessee Health Science Center, Memphis, in an oral presentation here on April 28^th at the 51^st Annual Meeting of the American College of Obstetricians and Gynecologists. "First we wanted to see if an ectopic pregnancy would impact the effectiveness of using methotrexate in a statistically significant way for a later ectopic pregnancy. Secondly, we wanted to see if prior use of methotrexate for an ectopic pregnancy would affect the same treatment for a later such pregnancy, again in a statistically significant way."

"Our study suggests that the answer to the former is yes and the later is no," he added.

The investigators studied the records of 489 consecutive patients who had ectopic pregnancies and were treated with single-dose, intra-muscular methotrexate. They eventually excluded nine who had undergone therapeutic surgery.

The researchers noted the variables among the patients pertaining to last menstruation, lab data, progesterone level at treatment, ectopic size and treatments for prior ectopic pregnancies. These variables were included in adjustments for statistical analysis of the patient subgroups, those who had had a prior ectopic pregnancy and those whose charts reflected their first such pregnancy.

Methotrexate therapy failed for 20% of 105 women with previous ectopic pregnancies, but in 7% of 375 women with first-time ectopic pregnancies (P=.001, odds ratio = 3.5).

"We saw a marked separation of percentages and, with the adjustments for other factors, the statistical significance of this difference held," said Dr. Lipscomb.

"This research shows rather powerfully that previous ectopic pregnancy is an independent cause of failure in subsequent methotrexate-treated ectopic pregnancies," he concluded. "We don't know why, but it appears to be the case."


[Study title: Previous Ectopic Pregnancy as a Risk Factor for Failure of Systemic Methotrexate Therapy.]

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