Research in Molecular Medicine

en Study of Factors Affecting the Failure of Methotrexate Treatment in Patients Diagnosed With Tubal Ectopic Pregnancy فارماسیوتیکس(داروسازی صنعتی) Pharmaceutics پژوهشي Research Background: Methotrexate (MTX) is the first-line treatment for stable tubal ectopic pregnancy(EP), but its failure can lead to serious complications. This study aimed to identify predictive factors for methotrexate treatment failure to improve patient selection. Methods: In this retrospective cross-sectional study, 371 patients with EP treated with a single-dose methotrexate regimen (50 mg/m²) at Rouhani Hospital, Babol (2013-2024) were analyzed. Demographic, clinical (β-hCG, pain), sonographic (mass size, free fluid), and inflammatory indices (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)) data were extracted from medical records. Treatment failure was defined as the need for surgery. Univariate and multivariate logistic regression were used to identify independent predictors, with ROC curves assessing their accuracy. Results: The treatment failure rate was 9.7% (n=36). Multivariate analysis identified a larger mass size (OR=1.32; 95%CI:1.15-1.52; p<0.001) and a higher systemic immune-inflammation index (SII) (OR=1.03; 95%CI:1.00-1.06; p=0.036) as significant independent predictors of failure. Higher red blood cell count and platelet distribution width were protective factors. ROC analysis demonstrated high predictive accuracy for mass size (AUC=0.85) and SII (AUC=0.82) in distinguishing treatment outcomes. Conclusion: Ectopic pregnancy mass size ≥23 mm and elevated SII are strong predictors of methotrexate treatment failure. These readily available parameters can serve as valuable tools for clinical decision-making, suggesting that primary surgery may be a preferable option for patients with these risk factors to avoid the complications of failed medical therapy.   Keywords: Ectopic pregnancy, methotrexate, treatment failure, inflammatory markers, NLR 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-1462-1&slc_lang=en&sid=1 Afsaneh Bashiri afsanehbashiri28@gmail.com 100319475328460013766 100319475328460013766 No Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Zinatossadat Bouzari Z_b412003@yahoo.com 100319475328460013767 100319475328460013767 Yes Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Mehrzad Netadj netadj@soc.msstate.edu 100319475328460013768 100319475328460013768 No Department of Sociology, Mississippi State University, USA. Shahla Yazdani Shahla_yazdani_1348@yahoo.com 100319475328460013769 100319475328460013769 No Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Soraya Khafri Khafri@yahoo.com 100319475328460013770 100319475328460013770 No Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran