Human Reproduction, Vol. 18, No. 9, 1802-1808,
September 2003
© 2003 European Society of Human Reproduction and Embryology
Medical treatment of ectopic pregnancies: a randomized clinical trial comparing methotrexate–mifepristone and methotrexate–placebo
1 Department of Obstetrics and Gynecology, Poissy–Saint Germain Hospital, University Versailles–St Quentin, 2 Department of Biostatistics, Saint Louis Hospital, University Paris VII, Assistance Publique—Hôpitaux de Paris, 3 Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, 4 Department of Obstetrics and Gynecology, C.M.C.O. Schiltighein, 5 Department of Obstetrics and Gynecology, C.H.R.U. Tours, 6 Department of Obstetrics and Gynecology, Hôtel Dieu Hospital, Rennes, 7 Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, 8 Department of Obstetrics and Gynecology, Paul Gelle Hospital, Roubaix, 9 Department of Obstetrics and Gynecology, Annecy Hospital, and 10 Department of Obstetrics and Gynecology, Evreux Hospital, France
11 To whom correspondence should be addressed at: Centre hospitalier Poissy–Saint Germain, Rue du Champ Gaillard, 78303 Poissy Cedex, France. e-mail: prozenberg{at}chi-poissy-st-germain.fr
BACKGROUND: Medical treatment of ectopic pregnancies is common. To increase the efficacy of methotrexate, the association of mifepristone has been proposed. METHODS: We performed a large prospective multicentre double-blind sequential randomized trial in order to compare the efficacy of methotrexate and mifepristone (600 mg given orally) versus methotrexate and placebo. RESULTS: A total of 212 ectopic pregnancies was randomized. There was no significant difference in the initial characteristics between the two groups. There was no significant difference in the success rate of medical treatment between the methotrexate–mifepristone (n = 113) and the methotrexate–placebo group (n = 99): 79.6% (90/113) versus 74.2% (72/97) respectively, RR (95% CI): 1.07 (0.92–1.25), P = 0.41, non-significant. However, there was a quantitative interaction between progesterone level and effect of treatment: when progesterone level was 
10 ng/l, the efficacy of the combination of mifepristone and methotrexate was significantly higher than the combination of methotrexate and placebo, with an 83.3% success rate (15/18) versus 38.5% (5/13) respectively. CONCLUSIONS: Our study failed to demonstrate any benefit of the addition of mifepristone to methotrexate. By contrast, the quantitative interaction between treatment effect and baseline serum progesterone suggested that this combination could be limited to ectopic pregnancies associated with high serum progesterone concentrations.
Key words: ectopic pregnancy/medical treatment/methotrexate/mifepristone/randomized controlled trial
* See Appendix for members of the GROG
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