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Objective <p>Ectopic pregnancy (EP) represents a severe risk to the health of pregnant women. Recently, the aromatase inhibitor letrozole has been explored as a potential novel treatment for managing EP. The aim of the present metanalysis is to pool the current data regarding the potential contribution of letrozole in treating EP, compared to methotrexate (MTX), in terms of serum beta-human chorionic gonadotropin (β-hCG) reduction.</p> Methods <p>A systematic search of the relevant literature published in PubMed, Science direct and Google Scholar was conducted. Original studies that directly compared letrozole with methotrexate (MTX) for the treatment of ectopic pregnancy (EP) were selected. Articles not written in English, those without a control group, or those whose control group did not involve pharmacological treatment with MTX were excluded. The Newcastle-Ottawa Scale instrument was used in order to assess the quality of non-randomized studies, while the quality of randomized-controlled trials (RCTs) was assessed in accordance with the Cochrane Risk Assessment Tool. The raw mean difference (MD) is used as outcome measure and the summary estimates along with the corresponding 95% confidence intervals (CI) by using a random effects model were calculated.</p> Results <p>Six studies have been included in the present metanalysis. A total of 373 women diagnosed with EP have been analyzed, 166 of them were treated with letrozole, while 207 women received MTX. The overall result indicates a faster and significant decrement of β-hCG levels in the letrozole group (MD -98.68; 95% CI [-162.38 -34.99], p-value = 0.0024; high heterogeneity I<sup>2</sup> = 95.95%, Q = 105.84, p-value &lt; 0.0001), in comparison to MTX.</p> Conclusion <p>The present data suggest that letrozole may represent a promising novel treatment for EP. However, the differences in study designs, small sample sizes, and the lack of comprehensive information regarding the short- and long-term safety of letrozole administered to patients with EP underscore the need for further research.</p>

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The embryotoxic properties of letrozole hold a promise in the treatment of ectopic pregnancy: a systematic review and metanalysis of the literature

  • 期刊论文

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  • 发表日期：

    2025年10月30日

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  • Maria Cristina Budani,
  • Stefania Fensore,
  • Chiara Passamonti,
  • Marco Di Marzio,
  • Gian Mario Tiboni

摘要

Objective

Ectopic pregnancy (EP) represents a severe risk to the health of pregnant women. Recently, the aromatase inhibitor letrozole has been explored as a potential novel treatment for managing EP. The aim of the present metanalysis is to pool the current data regarding the potential contribution of letrozole in treating EP, compared to methotrexate (MTX), in terms of serum beta-human chorionic gonadotropin (β-hCG) reduction.

Methods

A systematic search of the relevant literature published in PubMed, Science direct and Google Scholar was conducted. Original studies that directly compared letrozole with methotrexate (MTX) for the treatment of ectopic pregnancy (EP) were selected. Articles not written in English, those without a control group, or those whose control group did not involve pharmacological treatment with MTX were excluded. The Newcastle-Ottawa Scale instrument was used in order to assess the quality of non-randomized studies, while the quality of randomized-controlled trials (RCTs) was assessed in accordance with the Cochrane Risk Assessment Tool. The raw mean difference (MD) is used as outcome measure and the summary estimates along with the corresponding 95% confidence intervals (CI) by using a random effects model were calculated.

Results

Six studies have been included in the present metanalysis. A total of 373 women diagnosed with EP have been analyzed, 166 of them were treated with letrozole, while 207 women received MTX. The overall result indicates a faster and significant decrement of β-hCG levels in the letrozole group (MD -98.68; 95% CI [-162.38 -34.99], p-value = 0.0024; high heterogeneity I2 = 95.95%, Q = 105.84, p-value < 0.0001), in comparison to MTX.

Conclusion

The present data suggest that letrozole may represent a promising novel treatment for EP. However, the differences in study designs, small sample sizes, and the lack of comprehensive information regarding the short- and long-term safety of letrozole administered to patients with EP underscore the need for further research.