The role of early determination of β-human chorionic gonadotropin levels in predicting the success of single-dose methotrexate treatment in ectopic pregnancy

Abstract

Objective: The aim of the study was to determine the importance of β-hCG level on day 4 following methotrexate (MTX) administration, and the difference between β-hCG levels assessed on day 0 and day 4 in predicting treatment success. Material and methods:A total of 68 women with tubal pregnancy, treated with a single dose of MTX, were selected for this retrospective study. Results:The success rate of single-dose MTX treatment in our clinic was 75% (51/68). Among 51 patients in whom MTX treatment was successful, 25 (36.8%) showed a decrease in β-hCG level of > 15% on days 0 and 4, and 44 (64.7%) showed a β-hCG level decrease of > 15% on days 4 and 7. For subjects with β-hCG decrease of > 15% on days 4 and 7, the standard error was 6.5%, and the area under the ROC curve was 81.7%, while the corresponding values for days 0 and 4 were 7.2% and 64%, respectively. Conclusions:A decrease of > 15 % in β-hCG levels between days 0 and 4 does not seem to be a better predictor for success of single-dose MTX treatment for ectopic pregnancy than between days 4 and 7. A statistically significant difference was observed only in β-hCG levels on day 7 in both, successful and unsuccessful single-dose MTX groups.

Evaluation of pretreatment and early treatment changes in serum β-hCG with methotrexate

“…Çelik et al reported that a decreased percentage between days 1 and 4 did not seem to be a better predictor than that between days 4 and 7. 31 Girija et al reported that the MTX treatment could be successful not only in patients whose serum β-hCG levels decreased on the 4 th day, but also those whose serum β-hCG level increased on the 4 th day. They observed that a >50% increase in serum β-hCG levels in the first 4 days significantly increased the risk of MTX treatment failure, as in our study.…”

Tubal Ectopic Pregnancy: Effect of ß-hCG Change in Treatment

“…Side effects such as bone marrow depression, hepatotoxic, nephrotoxic mouth and intestinal mucosa are side effects. In addition, the effects of the drug are antagonized by externally administered folinic acid [13].…”