SynthesisAmerican journal of obstetrics and gynecology2019
Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis.
Synthesis in American journal of obstetrics and gynecology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed.
- Trial
- Methotrexate in relatively contraindicated ectopic pregnancies: who benefits from treatment?Archives of gynecology and obstetrics · 2026Article
- Microbiota of Cervical Canal in Nine Patients Diagnosed with Ectopic Pregnancy: Case Series.Life (Basel, Switzerland) · 2025Article
- Predictors of Methotrexate Success and Fertility Outcomes in Tubal Ectopic Pregnancy: A Retrospective Cohort Study.Medicina (Kaunas, Lithuania) · 2025Article
- Combating Methotrexate Resistance in Cancer Treatment: A Review on Navigating Pathways and Enhancing Its Efficacy With Fat-Soluble Vitamins.Scientifica · 2025Review
- Risk factors for methotrexate treatment failure in tubal ectopic pregnancy: a retrospective cohort study.BMC pregnancy and childbirth · 2024Article
- Enhancing decision-making in tubal ectopic pregnancy using a machine learning approach to expectant management: a clinical article.BMC pregnancy and childbirth · 2024Article
- Glutathione-Responsive Methotrexate Polymersomes for Potential Management of Ectopic Pregnancy.Small (Weinheim an der Bergstrasse, Germany) · 2024Article
- Methotrexate as the first-line treatment of unruptured tubular ectopic pregnancies with high initial human chorionic gonadotropin levels: A retrospective cohort.European journal of obstetrics & gynecology and reproductive biology: X · 2024Article
- Article
- Medical management of ectopic pregnancy: Case series at a private tertiary hospital, Tanzania.SAGE open medical case reports · 2024Article
- Predictive value of serum βHCG level in ectopic pregnancy: A cross sectional study.Health science reports · 2023Article
- The Very First Romanian Unruptured 13-Weeks Gestation Tubal Ectopic Pregnancy.Medicina (Kaunas, Lithuania) · 2022Article
- Caesarean Scar Pregnancy: A Case Report and a Literature Review.Medicina (Kaunas, Lithuania) · 2022Review
- Success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies.Experimental and therapeutic medicine · 2022Article
- Article
- Clinical Presentation as a Predictor of the Response to Methotrexate Therapy in Patients with Ectopic Pregnancy.Journal of pregnancy · 2022Article
- Time to resolution of tubal ectopic pregnancy following methotrexate treatment: A retrospective cohort study.PloS one · 2022Article
- Single-dose intramuscular methotrexate for treatment of cervical ectopic pregnancy: A case report.Case reports in women's health · 2021Article
- Combined surgical and medical management of a broad ligament ectopic pregnancy: A case report.Case reports in women's health · 2021Article
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5 authors.
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Abstract
objectiveTo compare the treatment success and failure rates, as well as side effects and surgery rates, between methotrexate protocols. DATA SOURCES: PubMed, Embase, and the Cochrane library searched up to July 2018. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that compared women with ectopic pregnancies receiving the single-dose, two-dose, or multi-dose methotrexate protocols. STUDY APPRAISAL AND SYNTHESIS
methodsOdds of treatment success, treatment failure, side effects, and surgery for tubal rupture, as well as length of follow-up until treatment success, were compared using random and fixed effects meta-analysis. Sensitivity analyses compared treatment success in the groups with high human chorionic gonadatropin (hCG) values and a large adnexal mass, as defined by individual studies. The Cochrane Collaboration tool was used to assess risk of bias.
resultsThe 2-dose protocol was associated with higher treatment success compared to the single-dose protocol (odds ratio [OR], 1.84; 95% CI, 1.13, 3.00). The 2-dose protocol was more successful in women with high hCG (OR, 3.23; 95% CI, 1.53, 6.84) and in women with a large adnexal mass (OR, 2.93; 95% CI, 1.23, 6.9). The odds of surgery for tubal rupture were lower in the 2-dose protocol (OR, 0.65; 95% CI, 0.26, 1.63), but this was not statistically significant. The length of follow-up was 7.9 days shorter for the 2-dose protocol (95% CI, -12.2, -3.5). The odds of side effects were higher in the 2-dose protocol (OR, 1.53; 95% CI, 1.01, 2.30). Compared to the single-dose protocol, the multi-dose protocol was associated with a nonsignificant reduction in treatment failure (OR, 0.56; 95% CI, 0.28, 1.13) and a higher chance of side effects (OR, 2.10; 95% CI, 1.24, 3.54). The odds of surgery for tubal rupture (OR, 1.62; 95% CI, 0.41, 6.49) and time to follow-up (OR, -1.3; 95% CI, -5.4, 2.7) were similar.
conclusionThe 2-dose methotrexate protocol is superior to the single-dose protocol for the treatment of ectopic pregnancy in terms of treatment success and time to success. Importantly, these findings hold true in patients thought to be at a lower likelihood of responding to medical management, such as those with higher hCGs and a large adnexal mass.
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