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Lookup NU author(s): Dr Beate Haugk,
Dr Sharmila Das,
Professor Alastair BurtORCiD,
Dr Christopher Record
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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.
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
ISSN (print): 0269-2813
ISSN (electronic): 1365-2036
PubMed id: 14871278
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