MIFEPRISTONE IN COMBINATION WITH METHOTREXATE FOR THE MEDICAL-TREATMENT OF TUBAL PREGNANCY - A RANDOMIZED, CONTROLLED TRIAL

In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organiz ed. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal pregnancy was confi rmed laparoscopically in 50 patients during a 2 year period. Women wer e randomized to receive a single i.m. injection of 50 mg/m(2) methotre xate alone or a single dose of 600 mg oral mifepristone in combination with the same dose of methotrexate. Both treatment protocols were suc cessful in achieving the resolution of unruptured ectopic pregnancy (1 8/25 in the methotrexate group and 22/25 in the combination group) fol lowing the initial intervention. A second injection was needed in four (16%) cases in the methotrexate group and in one (4%) case in the com bination group. Overall, a complete resolution was achieved in 22/25 a nd 23/25 cases respectively. Unruptured ectopic pregnancy resolved fas ter in women given the combination of methotrexate and mifepristone co mpared to women given methotrexate only (P = 0.01). The effect of the methotrexate and mifepristone combination was more pronounced in women with higher human chorionic gonadotrophin concentrations.