{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:27Z","timestamp":1786649667215,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ectopic pregnancy (EP) is one of the critical health conditions worldwide. Letrozole, an aromatase inhibitor that suppresses peripheral conversion of androgens to estrogens, has recently been introduced as a low-cost and minimal side effects treatment for EP. We studied the use of the letrozole for the treatment of EP in comparison with methotrexate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      This double-blind randomized clinical trial was conducted on 40 women with uncomplicated EP (into two groups of 20). The letrozole group received a daily regimen of 5 mg tablets for a duration of 10 days, while the methotrexate group received treatment via a single intramuscular injection of 50 mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      of body surface area.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean of aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin, and serum creatinine on the first and seventh days of treatment had no significant difference between the two groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). Although a significant decrease in beta human chorionic gonadotropin level was found in each of the two groups over time (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), there was no significant difference between the two groups on each of the fourth, seventh, and fourteenth days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). The level of anti-mullerian hormone in the methotrexate group with a mean of 2.22 \u00b1 1.23 ng\/mL was insignificantly higher than that of the letrozole group with a mean of 1.88 \u00b1 0.89 ng\/mL (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.425). The success rate of treatment in methotrexate group was 85%, and that in letrozole group was 70%, However, the difference between the two groups was not significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.282).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>According to the results of this study, the biochemical and hematological parameters and success treatment rate did not differ significantly between the administration of letrozole and methotrexate. Due to the occurrence of fewer side effects (although insignificant) in the administration of letrozole, it may be possible to introduce this drug as safer and less invasive than methotrexate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/abr.abr_530_24","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T14:01:59Z","timestamp":1767103319000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Letrozole and Methotrexate in the Management of Ectopic Pregnancy \u2013 A Randomized Clinical Trial Study"],"prefix":"10.4103","volume":"14","author":[{"given":"Farahnaz","family":"Mardanian","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faeze","family":"Ghasemi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdous","family":"Mehrabian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim","family":"Ghobadi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safora","family":"Roholamin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Haji","family":"Hashemi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12]]},"reference":[{"key":"R1-20251230","first-page":"599","article-title":"Ectopic pregnancy: Diagnosis and management","volume":"101","author":"Hendriks","year":"2020","journal-title":"Am Fam Physician"},{"key":"R2-20251230","doi-asserted-by":"crossref","first-page":"17455057231160349","DOI":"10.1177\/17455057231160349","article-title":"Overview of ectopic pregnancy diagnosis, management, and innovation","volume":"19","author":"Mullany","year":"2023","journal-title":"Womens Health (Lond)"},{"key":"R3-20251230","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40738-015-0008-z","article-title":"Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: A review","volume":"1","author":"Panelli","year":"2015","journal-title":"Fertil Res Pract"},{"key":"R4-20251230","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1148\/rg.2015140202","article-title":"Uncommon implantation sites of ectopic pregnancy: Thinking beyond the complex adnexal mass","volume":"35","author":"Chukus","year":"2015","journal-title":"Radiographics"},{"key":"R5-20251230","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1053\/j.semperi.2018.12.006","article-title":"Pregnancy of unknown location: Evaluation and management","volume":"43","author":"Carusi","year":"2019","journal-title":"Semin Perinatol"},{"key":"R6-20251230","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.jmig.2017.05.019","article-title":"Cesarean scar pregnancies: A systematic review of treatment options","volume":"24","author":"Maheux-Lacroix","year":"2017","journal-title":"J Minim Invasive Gynecol"},{"key":"R7-20251230","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.fertnstert.2020.04.001","article-title":"Aromatase inhibitor letrozole: A novel treatment for ectopic pregnancy","volume":"114","author":"Mitwally","year":"2020","journal-title":"Fertil Steril"},{"key":"R8-20251230","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.3390\/microorganisms10102053","article-title":"The protective effects of nutraceutical components in methotrexate-induced toxicity models-an overview","volume":"10","author":"Marin","year":"2022","journal-title":"Microorganisms"},{"key":"R9-20251230","doi-asserted-by":"crossref","first-page":"14230","DOI":"10.3390\/ijerph192114230","article-title":"Future perspectives of ectopic pregnancy treatment-review of possible pharmacological methods","volume":"19","author":"Leziak","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"R10-20251230","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1007\/s43032-022-00993-0","article-title":"Evaluation of different doses of the aromatase inhibitor letrozole for the treatment of ectopic pregnancy and its effect on villous trophoblastic tissue","volume":"29","author":"Alabiad","year":"2022","journal-title":"Reprod Sci"},{"key":"R11-20251230","first-page":"34","article-title":"Diagnosis and management of ectopic pregnancy","volume":"90","author":"Barash","year":"2014","journal-title":"Am Fam Physician"},{"key":"R12-20251230","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00404-003-0543-4","article-title":"Single-dose methotrexate for the treatment of unruptured ectopic pregnancy","volume":"270","author":"Erdem","year":"2004","journal-title":"Arch Gynecol Obstet"},{"key":"R13-20251230","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s00404-019-05068-1","article-title":"Can early \u03b2hCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy?","volume":"299","author":"Brunello","year":"2019","journal-title":"Arch Gynecol Obstet"},{"key":"R14-20251230","doi-asserted-by":"crossref","first-page":"2688","DOI":"10.1093\/humrep\/dep277","article-title":"Impact of estrogen replacement on letrozole-induced embryopathic effects","volume":"24","author":"Tiboni","year":"2009","journal-title":"Hum Reprod"},{"key":"R15-20251230","doi-asserted-by":"crossref","first-page":"49","DOI":"10.30699\/jogcr.3.2.49","article-title":"Comparison of using misoprostol with or without letrozole in abortion induction: A placebo-controlled clinical trial","volume":"3","author":"Javanmanesh","year":"2022","journal-title":"J Obstet Gynecol Cancer Res"},{"key":"R16-20251230","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/humupd\/dmn033","article-title":"Reproductive endocrinology interest group of Spanish society of fertility. Use of letrozole in assisted reproduction: A systematic review and meta-analysis","volume":"14","author":"Requena","year":"2008","journal-title":"Hum Reprod Update"},{"key":"R17-20251230","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0950-351X(05)80048-5","article-title":"The endocrinology of implantation and early pregnancy","volume":"4","author":"Bonney","year":"1990","journal-title":"Baillieres Clin Endocrinol Metab"},{"key":"R18-20251230","first-page":"69","article-title":"Use of a specific aromatase inhibitor for determining whether there is a role for oestrogen in follicle\/oocyte maturation, ovulation and preimplantation embryo development","volume":"50","author":"Moudgal","year":"1996","journal-title":"J Reprod Fertil Suppl"},{"key":"R19-20251230","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/S0002-9378(00)70235-3","article-title":"The role of estrogen in the maintenance of primate pregnancy","volume":"182","author":"Albrecht","year":"2000","journal-title":"Am J Obstet Gynecol"},{"key":"R20-20251230","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1080\/14767058.2019.1638899","article-title":"The efficacy of letrozole supplementation for medical abortion: A meta-analysis of randomized controlled trials","volume":"34","author":"Zhuo","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"R21-20251230","doi-asserted-by":"crossref","first-page":"341","DOI":"10.33545\/gynae.2021.v5.i1f.834","article-title":"Resolution of chronic ectopic pregnancy with letrozole","volume":"5","author":"Kochhar","year":"2021","journal-title":"Int J Clin Obstet Gynaecol"},{"key":"R22-20251230","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.fertnstert.2020.04.063","article-title":"Letrozole: Future alternative to methotrexate for treatment of ectopic pregnancy?","volume":"114","author":"Auger","year":"2020","journal-title":"Fertil Steril"},{"key":"R23-20251230","doi-asserted-by":"crossref","first-page":"851","DOI":"10.21608\/amj.2022.230453","article-title":"Compared study between the use of ietrozole and methotrexate for the medical treatment of early suspecious undisturbed tubal ectopic pregnancy","volume":"51","author":"Nabil","year":"2022","journal-title":"Al-Azhar Med J"}],"container-title":["Advanced Biomedical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/abr.abr_530_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:56:44Z","timestamp":1786647404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/abr.abr_530_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/abr.abr_530_24","relation":{},"ISSN":["2277-9175"],"issn-type":[{"value":"2277-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2024-10-23","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}