Dear Editor,
We would like to share ideas on the publication “Medical Treatment for Ectopic Pregnancy
during the COVID-19 Pandemic.” Elito Júnior and Araujo Júnior[1] mentioned that the “clinical treatment of ectopic pregnancy by MTX or expectant management is an alternative
during the COVID-19 pandemic. An early diagnosis and appropriate selection of treatment
options are critical for the success of the treatment.”[1] In fact, using methotrexate (MTX) as alternative treatment for ectopic pregnancy
during COVID-19 is a useful approach, and can reduce risk as well as decrease the
workload at the hospital. The patient selection is very important. However, it should
be noted that MTX might cause renal impairment,[2] and COVID-19 has a trend to develop renal impairment due to the immunopathological
process of infection.[3] Close monitoring of the renal function is needed in MTX therapy, and the adjustment
of the dosage based on renal function is important.[4]
Author's response
Reply to “Management of Ectopic Pregnancy and the COVID-19 Pandemic”
Júlio Elito Júnior,1 0000-0003-1514-5504 Edward Araújo Júnior1 0000-0002-6145-2532
1Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São
Paulo, São Paulo, SP, Brazil
Address for correspondence: Edward Araújo Júnior, Departmento de Obstetrícia, Escola
Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740, Vila Clementino,
São Paulo, SP, 04023-062, Brazil (e-mail: araujojred@terra.com.br).
Dear Editor,
Thank you for your comments. The most important message of this letter was the correct
selection of patients for the medical treatment with methotrexate (MTX). We mentioned
in the third paragraph that one of the exclusion criteria was renal dysfunction. Therefore,
before the treatment, blood samples of every patient were collected for some exams,
and one of them was creatinine. High levels of creatine were an exclusion criterion
for the MTX treatment. On the other hand, patients with normal levels of creatinine
can be submitted to the medical treatment. For tubal pregnancies, we recommend a single
dose of MTX (50 mg/m2). The risk of renal impairment related to this dose is very rare.[1] However, close monitoring of the renal function is necessary in cases of non-tubal
pregnancies submitted to the protocol of multiple doses of MTX.
Conflict of Interests
The authors have no conflict of interests to declare.
