I was unlucky enough to have my second ectopic pregnancy at the beginning of the year and I’ll be writing about that soon but with ectopics majorly on my mind I turned to expert in the field Professor Horne who works so closely with a charity that I hold dearly, and who ask for these important pieces to be written for My Baba and that is Wellbeing of Women.
This piece is about all about the current research Professor Horne and his team from Edinburgh are working on and it’s gives me great hope for all those women out there, who, like me have and will have to deal with ectopic pregnancies.
An ectopic pregnancy occurs where an embryo implants outside of the womb. Over 98% implant in the Fallopian tube. If an ectopic pregnancy continues to grow there is commonly stretching and ultimately rupture of the tube causing life-threatening, internal bleeding. Fortunately, in countries where ultrasound scans and pregnancy hormone (hCG) blood testing are widely available, most ectopic pregnancies are now diagnosed before they rupture. Management of an unruptured ectopic pregnancy depends on symptoms, pregnancy size, presence of internal bleeding, and hCG measurement.
When a patient has a high risk of rupture as evident from severe symptoms, a large ectopic pregnancy, internal bleeding or a high hCG level, then surgery is the best treatment. In the remaining women, a methotrexate injection is a suitable treatment. However, in 30% of women, methotrexate treatment is unsuccessful (with surgery still required). In 15% of women, it is partially effective (2nd dose of methotrexate required). For many women, treatment is prolonged (many hospital visits) adding to emotional distress. A more effective treatment is necessary to reduce the need for emergency surgery, the requirement of repeat treatment and the prolonged time to complete treatment.
Gefitinib is a drug taken by mouth that is licensed to treat a type of lung cancer. Edinburgh University researchers, in collaboration with the University of Melbourne, have performed three small studies using methotrexate and gefitinib. In the first study (laboratory based), the research team found that ectopic pregnancy tissue responds to gefitinib and that it improves the effect of methotrexate. In the second and third studies (called GEM1 and GEM2), the researchers found that giving methotrexate and gefitinib together to women with ectopic pregnancy may reduce the need for surgery and hospital visits. Using the drugs together did not cause any important side effects. These findings now require further study in a large trial and to reach a better understanding of how gefitinib works.
Professor Andrew Horne and his team from Edinburgh are therefore starting a large multicentre clinical trial in the summer of 2016 (funded by the NIHR) to compare using methotrexate and gefitinib together with using methotrexate and placebo (dummy drug). All of the women who agree to participate in the trial will receive methotrexate (normal treatment dose) and also be randomly allocated to take either a gefitinib, or a placebo tablet, once a day for 7 days. His team will assess whether the two drugs together are better than methotrexate with placebo at treating the ectopic pregnancy without the need for surgery. They will also compare how long the hCG level takes to decrease, the number of hospital visits and the need for further methotrexate, as well as safety and patient acceptability between the study groups. To monitor treatment response, his team will collect blood samples twice in the first week after treatment then weekly to measure hCG levels until they drop to non pregnant levels. The trial will recruit 328 women from around 50 UK hospitals. Professor Horne believes that the drugs together will be of greater benefit to women with ectopic pregnancy in terms of fewer operations, hospital visits and blood tests.
Professor A. Horne for Wellbeing of Women
Tel: 020 3697 7000
Address: First Floor, Fairgate House, 78 New Oxford Street, London WC1A 1HB