Overview and guidelines of off-label use of methotrexate in ectopic ă pregnancy: report by CNGOF

Henri Marret, Arnaud Fauconnier (), Gil Dubernard, Helene Misme, Laurence Lagarce, Magali Lesavre, Hervé Fernandez, Camille Mimoun, Claire Tourette, Sandra Curinier, Benoit Rabishong and Aubert Agostini
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Arnaud Fauconnier: RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
Gil Dubernard: UMRS893 - Centre de Recherche Saint-Antoine - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale, Service d'Anesthésie et de Soins Intensifs [Hôpital de la Croix-Rousse - HCL] - Hôpital de la Croix-Rousse [CHU - HCL] - HCL - Hospices Civils de Lyon
Hervé Fernandez: Service de Gynécologie Obstétrique - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)

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Abstract: Our objective is to describe off-label use of methotrexate in ectopic ă pregnancy treatment using evidence based medicine. The patient group ă includes all women with a pregnancy outside the usual endometrium, or of ă unknown location. ă Method used was a Medline search on ectopic pregnancy managed using ă methotrexate treatment; evidence synthesis was done based on this ă current literature analysis. ă Level of evidence (LE) were given according to the centre for evidence ă base medicine rules. Grade was proposed for guidelines but no ă recommendation was possible as misoprostol is off label use for all the ă indications studied. ă In the absence of any contraindication, the protocol recommended for ă medical treatment of ectopic pregnancy is a single intramuscular ă injection of methotrexate (MTX) at a dosage of 1 mg/kg or 50 mg/m(2) ă (Grade A). It can be repeated once at the same dose should the hCG ă concentration not fall sufficiently. Pretreatment laboratory results ă must include a complete blood count and kidney and liver function tests ă (in accordance with its marketing authorization). ă MTX is an alternative to conservative treatment such as laparoscopic ă salpingotomy for uncomplicated tubal pregnancy (Grade A) with ă pretreatment hCG levels 20001U/1, routine MTX treatment is an option. ă MTX is not indicated for combination with treatments such as ă mifepristone or potassium. (C) 2016 Published by Elsevier Ireland Ltd.

Keywords: quality (search for similar items in EconPapers)
Date: 2016-10
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Published in European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016, 205, pp.105-109. ⟨10.1016/j.ejogrb.2016.07.489⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01482368

DOI: 10.1016/j.ejogrb.2016.07.489

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