Systematic Review Of The Effectiveness Of Multidose And Single-Dose Methotrexate Treament For Ectopic Pregnancy

OBJECTIVE: To evaluate the effectiveness of the single-dose and multidose methotrexate treatment for ectopic pregnancy.METHODS: We electronically searched six databases( from 1992 to 2010), PubMed,The Cochrane libraly,Medline,CNKI,VIP,Wangfang database and seven journals( from 1992 to 2010) were searched by hand。Only controlled clinical trials(CCTs) about comparisons of the effectiveness of the single-dose and multidose methotrexate treatment for ectopic pregnancy were included. two reviewers screened the eligible studies,evaluated the quality and extracted the data from the included studies on thier own. Meta-analysis was done by Revman5.0.25 to the extracted data,the results were expressed with OR and 95%CI . The evaluated results include success rate, gastrointestinal reaction rate, oral mucosal damaged rate, myelosuppression rate, hepatic funtion damaged rate, abdominal pain rate and repeat administration rate. heterogeneity test was done first,when datas without heterogeneity could be pooled using fixed effect model and those with heterogeneity could be worked out by sensitivity analysis or randomized effect model.RESULTS: Eleven published CCTs with total 1,096 participants were included in comparing with two doses methotrexate treatment for ectopic pregnancy. All the included studies ,which had an ectopic gestation mass≤5cm, serum beta-HCG<6000U/L: single-dose showed higher success rate[OR=2.04, 95%C(I1.46,2.84),P<0.0001], but lower failure rate [OR=0.39,95%C(I0.25,0.61),P<0.0001]; and gastrointestinal reaction rate[OR=0.88,95%CI(0.45,1.72),P=0.70], oral mucosal damaged rate[OR=0.96,95%CI(0.50,1.83),P=0.89], myelosuppression rate[OR=0.55,95%C(I0.27,1.10),P=0.09], hepatic funtion damaged rate[OR=0.54,95%CI(0.27,1.09),P=0.09], abdominal pain rate[OR=1.02,95%CI(0.57,1.83),P=0.94] and repeat administration rate[OR=1.20,95%CI(0.56,2.59),P=0.64]were showed no significant differences.when patients with an ectopic pregnancy≤4cm in size,β-HCG<2000U/L: single-dose and multidose showed no significant differences in success rate[OR=1.34,95%CI(0.79,2.28),P=0.28], failure rate [OR=0.55,95%CI(0.29,1.06),P=0.07], gastrointestinal reaction rate [OR=1.43,95%CI(0.57,3.56),P=0.45], oral mucosal damaged rate [OR=0.87,95%CI(0.28,2.71),P=0.81], myelosuppression rate [OR=1.28,95%C(I0.34,4.86),P=0.72], hepatic funtion damaged rate [OR=0.19,95%CI(0.01,4.05),P=0.28] and repeat administration rate [OR=2.42,95%CI(0.44,13.44),P=0.31].CONCLUSIONS: When all the included studies which patients had an ectopic gestation mass≤5cm,serum beta-HCG < 6000U/L, single-dose methotrexate treatment for ectopic pregnancy showed more superiority than multidose . When ectopic gestation mass≤4cm,serum beta-HCG<2000U/L, single-dose and multidose methotrexate treatment for ectopic pregnancy showed no correlation in success rate,side effect rates and repeat administration rate. This result showed that single-dose and multidose methotrexate treatment for ectopic pregnancy is closely related to the base serum beta-HCG and have something to do with diameter of ectopic gestation .