Tarafdari Azadeh, Keikha Fatemeh, Asadi Fatemeh, Hantoushzadeh Sedigheh, Gargari Omid Kohandel, Forouzin Maryam, Ghaemi Marjan
Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Reprod Sci. 2024 Dec;31(12):3651-3659. doi: 10.1007/s43032-024-01712-7. Epub 2024 Oct 9.
This systematic review and meta-analysis aimed to investigate the effect of letrozole alone or in combination with Methotrexate on the management of ectopic pregnancy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were applied for reporting. The EMBASE, PubMed, Scopus, and Web of Science databases were searched for relevant studies focused on women diagnosed with ectopic pregnancy and managed non-surgically with letrozole alone or in combination with methotrexate (MTX) until April 2024. The success rate, laboratory findings, and complications were analyzed and reported. Meta-analysis was done using RevMan 5.4.1 software. Out of 129 unique studies obtained, 7 of them were found eligible for final review; of which, 3 were nonrandomized prospective cohort studies, 2 were randomized clinical trials, and 2 study were case studies. In 5 studies letrozole was used as monotherapy. While in another study letrozole was used with MTX. The meta-analysis showed a significantly lower level of β-HCG in the letrozole group compared to MTX, 7 days after initiation of treatment (Fixed effect model, MD = -92.22, 95%CI: [-159.39, -25.04], P = 0.007, I2 = 0%). There was no significant difference in the level of anti-mullerian hormone (AMH) between groups (Fixed effect model, MD = 0.18, 95%CI: [-0.09, 0.45], P = 0.20, I2 = 0%). Success rate, platelet count, and level of liver enzymes seemed to be better or similar among patients receiving Letrozole compared to patients receiving Methotrexate. Letrozole exhibits potential as a therapeutic option for ectopic pregnancies; however, further randomized clinical trials are necessary to establish strong evidence.
本系统评价和荟萃分析旨在研究来曲唑单独使用或与甲氨蝶呤联合使用对异位妊娠治疗的效果。采用系统评价和荟萃分析的首选报告项目（PRISMA）进行报告。检索了EMBASE、PubMed、Scopus和Web of Science数据库，以查找截至2024年4月的相关研究，这些研究聚焦于被诊断为异位妊娠且采用来曲唑单独或与甲氨蝶呤（MTX）联合进行非手术治疗的女性。分析并报告了成功率、实验室检查结果和并发症。使用RevMan 5.4.1软件进行荟萃分析。在获得的129项独特研究中，发现7项符合最终审查标准；其中，3项为非随机前瞻性队列研究，2项为随机临床试验，2项为病例研究。5项研究将来曲唑用作单一疗法。而在另一项研究中，来曲唑与MTX联合使用。荟萃分析显示，与MTX相比，来曲唑组在治疗开始7天后β-HCG水平显著降低（固定效应模型，MD = -92.22，95%CI：[-159.39, -25.04]，P = 0.007，I2 = 0%）。两组之间抗苗勒管激素（AMH）水平无显著差异（固定效应模型，MD = 0.18，95%CI：[-0.09, 0.45]，P = 0.20，I2 = 0%）。与接受甲氨蝶呤的患者相比，接受来曲唑治疗的患者成功率、血小板计数和肝酶水平似乎更好或相似。来曲唑作为异位妊娠的一种治疗选择具有潜力；然而，需要进一步的随机临床试验来确立有力证据。
