HOME
Return to Table of Contents
240 METHOTREXATE TREATMENT IN PSORIASIS: TO BIOPSY OR NOT TO BIOPSY SA Alqahtani1, WK Alhamoudi1, AM Shaheen1, SJ Urbanski2, MG Swain1 BACKGROUND: Methotrexate (MTX) has been used for decades for the treatment of psoriasis. Long-term use of MTX has been associated with significant liver damage, although of unclear frequency. Since liver tests are often normal in the setting of even cirrhosis while taking MTX, liver biopsy has been advocated as the best means for following these patients.
1Liver Unit; 2Department of Pathology, University of Calgary, Calgary, Alberta
OBJECTIVE: Therefore, we undertook this study in an effort to determine more precisely the utility of liver biopsy for following patients taking MTX for psoriasis, and in addition to correlate liver biopsy findings with clinical parameters associated with potential liver toxicity from MTX.
METHODS: 37 patients who were taking MTX chronically to treat psoriasis and who underwent liver biopsy were evaluated. Data were obtained from the pathology department registration computer system from January 1999 to September 1, 2006. The patient charts were assessed for the following; patient age, gender, other risk factors for liver disease, cumulative MTX dose, duration of MTX treatment, routine lab values and degree of MTX-related hepatotoxicity on liver biopsy.
RESULTS: Thirty seven patients were included, most were female (n=21, 56.8%), average age 52±11 years, and average weight 91.8±15.6 kg. Subjects received a median cumulative MTX dose of 2 g (range: 0.8-33) over a median duration of 60 weeks (range:12-720). Seventeen patients (45.9%) were social drinkers while 7 patients were heavy drinkers (18.9%) (Defined as more than 14 drinks/week for male and >7 drinks/week for female. Three patients (8.1%) were diabetic. Liver biopsy staging using the Roenigk score was: 24 (64.9%) were grade 1, 8 (21.6%) were grade 2, 5 (13.5%) were grade 3a, and none with grade 3b or 4. Liver biopsy staging was significantly positively correlated with age (P=0.022), AST (P=0.003), and GGT (P=0.004). With no correlation with MTX cumulative dose (P=0.17), usage duration (P=0.36) alcohol intake (P=0.48), patient weight (P=0.1), ALT (P=0.248), Bilirubin (P= 0.09) or Alk Phosphatase (P=0.14).
CONCLUSIONS: Our results indicate that liver biopsy findings in psoriatic patients taking MTX do not correlate with duration of therapy, cumulative dose, weight, or alcohol intake (there were too few diabetics to allow us to comment). Finally, no patient developed cirrhosis despite MTX therapy of up to 33 g total dose and a duration of therapy of up to almost 14 years. Our results question the need for sequential liver biopsies in these patients.