Toggle Main Menu Toggle Search

Open Access padlockePrints

Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: Are serial liver biopsies justified?

Lookup NU author(s): Dr Beate Haugk, Dr Sharmila Das, Professor Alastair BurtORCiD, Dr Christopher Record


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


Background: Reports that up to 26% of subjects with psoriasis develop cirrhosis have led to a recommendation of serial liver biopsies after each cumulative dose of 1500 mg of methotrexate. Aim: To evaluate the progression of liver injury in patients with psoriasis and the impact of monitoring by liver biopsy on their management. Methods: One hundred and twenty-one liver biopsies from 66 subjects (aged 11-79 years) with psoriasis, receiving a median cumulative dose of 3206 mg of methotrexate over a period of 280.5 weeks, were evaluated. Results: The assessment of advanced fibrosis according to the Ishak system (≥ 4) correlated perfectly with that of the Scheuer system (≥ 3) and poorly with that of the Roenigk scale (≥ 3b) (r2 = 1.0 and 0.31, respectively). Two of 24 pre-treatment biopsies showed advanced fibrosis and both subjects were heavy drinkers. The cumulative probabilities of advanced fibrosis (Ishak ≥ 4) were 0%, 2.6%, 2.6%, 8.2% and 8.2% at cumulative doses of 1500, 3000, 4500, 5000 and 6000 mg, respectively. None of the subjects developed cirrhosis during follow-up or discontinued therapy on the basis of liver biopsy findings. Conclusions: Advanced hepatic fibrosis with low-dose methotrexate therapy is much less frequent than previously reported. Pre-treatment or monitoring liver biopsies in accordance with the current guidelines have little impact on patient management.

Publication metadata

Author(s): Aithal GP, Haugk B, Das S, Card T, Burt AD, Record CO

Publication type: Article

Publication status: Published

Journal: Alimentary Pharmacology and Therapeutics

Year: 2004

Volume: 19

Issue: 4

Pages: 391-399

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036

Publisher: Wiley-Blackwell


DOI: 10.1046/j.1365-2036.2004.01819.x

PubMed id: 14871278


Altmetrics provided by Altmetric