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, I²=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, I²=0%). Conclusions: The single-dose methotrexate protocol was the optimal protocol for the medical treatment of ectopic pregnancy.