Among 320 women in whom treatment was successful (91%) the mean serum chorionic gonadotropin concentration was 4 019 (SE 6 362), while it was 13 420 (SE 16 590) in those in whom the treatment was unsuccessful 1.
A systematic review 2 included 5 observational studies with a total of 503 women using single-dose methotrexate stratified by initial hCG concentration. Failure rates increase with increasing hCG levels. A significant increase in failure rates was seen when comparing patients with initial hCG levels over 5 000 mIU/mL with those with initial levels under 5 000 mIU/mL (odds ratio 5.45; 95% CI 3.04 to 9.78). The failure rate with hCG between 5 000 and 9 999 mIU/mL was significantly higher than with hCG between 2 000 and 4 999 mIU/mL (odds ratio 3.76; 95% CI 1.16 to 12.33).
A clinical trial 3 investigated pretreatment hCG cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. 53 women received a single-dose regimen and 32 women received a multi-dose regimen. Medical treatment failure was defined as necessity of surgical treatment. Treatment success rate was 64.2% in the single-dose group and 71.9% in the multi-dose group (P>0.05). Pretreatment serum hCG titer was an independent prognostic factor for treatment success in each regimen. Serum hCG cutoff value to predict the treatment success was 3 026 IU/L in single-dose regimen group and 3 711 IU/L in multi-dose regimen group.
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