Systematic review and meta-analysis of single-dose and non-single-dose methotrexate protocols in the treatment of ectopic pregnancy.

BACKGROUND

It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate.

OBJECTIVE

To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy.

SEARCH STRATEGY

Various databases including Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy."

SELECTION CRITERIA

Randomized controlled trials comparing different methotrexate protocols for the treatment of ectopic pregnancy were included.

DATA COLLECTION AND ANALYSIS

Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare treatment success rates and adverse effect rates.

MAIN RESULTS

The single-dose and non-single-dose protocols had similar success rates (RR 1.00, 95% CI 0.96-1.04; 11 trials, 1121 patients, I =18%). The non-single-dose protocols had a higher adverse effect rate than did the single-dose protocol (RR 0.73, 95% CI 0.59-0.91; nine trials, 934 patients, I =0%).

CONCLUSIONS

The single-dose methotrexate protocol was the optimal protocol for the medical treatment of ectopic pregnancy.