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American Journal of Clinical Dermatology

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01-12-2005 | Leading Article

Monitoring Liver Function during Methotrexate Therapy for Psoriasis

Are Routine Biopsies Really Necessary?

Authors: James A. Thomas, Dr Guruprasad P. Aithal

Published in: American Journal of Clinical Dermatology | Issue 6/2005

Abstract

Methotrexate is a widely used and efficacious treatment for psoriasis. Current recommendations advise liver biopsy after each cumulative 1–1.5g dosage of methotrexate. Although studies of methotrexate hepatotoxicity in psoriasis are of variable quality, the evidence indicates that in patients with no risk factors for liver disease on long-term, low-dosage (<20mg), once-weekly methotrexate, liver biopsy is justified after an initial cumulative dosage of 4g. Advances in the non-invasive assessment of liver fibrogenesis may eventually further reduce the need for biopsy.

Gubner R. Effect of aminoptedn on epithelial tissues. Arch Derm Syphilol. 1951; 64 (6): 688–99CrossRef

Zachariae H. Methotrexate side effects. Br J Dermatol. 1990; 122 Suppl. 36: 127–33

Collins P, Rogers S. The efficacy of methotrexate in psoriasis: a review of 40 cases. Clin Exp Dermatol; 1992; 17 (4): 257–60PubMedCrossRef

Van Dooren Greebe RJ, Kuijpers AL, Mulder J, et al. Methotrexate revisited: effects of long-term treatment in psoriasis. Br J Dermatol. 1994; 130 (2): 204–10PubMedCrossRef

Callen JP. Methotrexate. In: Kulp-Shorten CL, Wolverton SE, editors. Comprehensive dermatologic drug therapy. Philadelphia (PA): WB Saunders Company, 2001:147–64

Tang H, Neuberger J. Review article: methotrexate in gastroenterology: dangerous villain or simply misunderstood?. Aliment Pharmacol Ther. 1996; 10 (6): 851–8PubMedCrossRef

Nair MG, Baugh CM. Synthesis and biological evaluation of poly-gammaglutamyl derivatives of methotrexate. Biochemistry. 1973; 12 (20): 3923–7PubMedCrossRef

Chabner BA, Allegra CJ, Curt GA, et al. Polyglutamation of methotrexate: is methotrexate a prodrug?. J Clin Invest. 1985; 76 (3): 907–12PubMedCrossRef

Barak AJ, Tuma DJ, Beckenhauer HC. Methotrexate hepatotoxicity. J Am Coll Nutr. 1984; 3 (1): 93–6PubMed

10.

Roenigk Jr HH, Maibach HI, Weinstein GD. Use of methotrexate in psoriasis. Arch Dermatol. 1972; 105 (3): 363–5PubMedCrossRef

11.

Roenigk Jr HH, Auerbach R, Maibach HI, et al. Methotrexate therapy for psoriasis: guideline revisions [abstract]. Arch Dermatol. 1973; 108 (1): 35PubMedCrossRef

12.

Roenigk Jr HH, Auerbach R, Maibach HI, et al. Methotrexate guidelines: revised. J Am Acad Dermatol. 1982; 6 (2): 145–55PubMedCrossRef

13.

Auerbach R, Maibach HI, Roenigk Jr HH, et al. Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol. 1988; 19 (1): 145–56PubMedCrossRef

14.

Roenigk Jr HH, Auerbach R, Maibach H, et al. Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol. 1998; 38 (3): 478–85PubMedCrossRef

15.

Boffa MJ, Chalmers RJ, Haboubi NY, et al. Sequential liver biopsies during longterm methotrexate treatment for psoriasis: a reappraisal. Br J Dermatol. 1995; 133 (5): 774–8PubMedCrossRef

16.

Zachariae H. Liver biopsies and methotrexate: a time for reconsideration?. J Am Acad Dermatol. 2000; 42 (3): 531–4PubMedCrossRef

17.

Aithal GP, Haughk B, Das S, et al. Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?. Aliment Pharmacol Ther. 2004;19 (4): 391–9PubMedCrossRef

18.

O’Rourke RA, Eckert GE. Methotrexate-induced hepatic injury in an adult: a case report. Arch Intern Med; 1964; 113: 191–4PubMedCrossRef

19.

Zachariae H, Kragballe K, Søgaard H. Methotrexate induced liver cirrhosis: studies including serial liver biopsies during continued treatment. Br J Dermatol; 1980; 102 (4): 407–12PubMedCrossRef

20.

Reese LT, Grisham JW, Aach RD, et al. Effects of methotrexate on the liver in psoriasis. J Invest Dermatol. 1974; 62 (6): 597–602PubMedCrossRef

21.

Robinson JK, Boughman RD, Auerbach R, et al. Methotrexate hepatotoxicity in psoriasis: consideration of liver biopsies at regular intervals. Arch Dermatol. 1980; 116 (4): 413–5PubMedCrossRef

22.

Lanse SB, Arnold GL, Gowans JD, et al. Low incidence of hepatotoxicity associated with long-term, low-dose oral methotrexate in treatment of refractory psoriasis, psoriatic arthritis, and rheumatoid arthritis: an acceptable risk/benefit ratio. Dig Dis Sci. 1985; 30 (2): 104–9PubMedCrossRef

23.

Mitchell D, Smith A, Rowan B, et al. Serum type III procollagen peptide, dynamic liver function tests and hepatic fibrosis in psoriatic patients receiving methotrexate. Br J Dermatol. 1990; 122 (1): 1–7PubMedCrossRef

24.

Themido R, Loureiro M, Pecegueiro M, et al. Methotrexate hepatotoxicity in psoriatic patients submitted to long-term therapy. Acta Derm Venereol. 1992; 72 (5): 361–4PubMed

25.

Malatjalian DA, Ross JB, Williams CN, et al. Methotrexate hepatotoxicity in psoriatics: report of 104 patients from Nova Scotia, with analysis of risks from obesity, diabetes and alcohol consumption during long term follow-up. Can J Gastroenterol. 1996; 10 (6): 369–75PubMed

26.

Kremer JM, Lee RG, Tolman KG. Liver histology in rheumatoid arthritis patients receiving long-term methotrexate therapy: a prospective study with baseline and sequential biopsy samples. Arthritis Rheum. 1989; 32 (2): 121–7PubMedCrossRef

27.

Pestana A, Halprin KM, Taylor JR, et al. Predictive value of HLA antigen for methotrexate-induced liver damage in patients with psoriasis. J Am Acad Dermatol. 1985; 12 (1): 26–9PubMedCrossRef

28.

Weinstein G, Roenigk HH, Maibach H, et al. Psoriasis-liver-methotrexate interactions. Arch Dermatol. 1973; 108: 36–42CrossRef

29.

Ashton RE, Milward-Sadler GH, White JE. Complications in methotrexate treatment of psoriasis with particular reference to liver fibrosis. J Invest Dermatol. 1982; 79 (4): 229–32PubMedCrossRef

30.

Whiting-O’Keefe QE, Fye KH, Sack KD. Methotrexate and histologic hepatic abnormalities: a meta-analysis. Am J Med. 1991; 90 (6): 711–6PubMedCrossRef

31.

Newman M, Auerbach R, Feiner H, et al. The role of liver biopsies in psoriatic patients receiving long-term methotrexate treatment: improvement in liver abnormalities after cessation of treatment. Arch Dermatol. 1989; 125 (9): 1218–24PubMedCrossRef

32.

Dahl MG, Gregory MM, Scheuer PJ. Methotrexate hepatotoxicity in psoriasis: comparison of different dose regimens. BMJ. 1972; 1 (801): 654–6PubMedCrossRef

33.

Podurgiel BJ, McGill DB, Ludwig J, et al. Liver injury associated with methotrexate therapy for psoriasis. Mayo Clin Proc. 1973; 48 (11): 787–92PubMed

34.

Nyfors N. Liver biopsies from psoriatics related to methotrexate therapy: 3. Findings in post-methotrexate liver biopsies from 160 psoriatics. Acta Pathol Microbiol Scand. 1977; 85 (4): 511–8

35.

West SG. Methotrexate hepatotoxicity. Rheum Dis Clin North Am. 1997; 23 (4): 883–915PubMedCrossRef

36.

Brunt EM. Grading and staging the histopathological lesions of chronic hepatitis: the Knodell Histology Activity Index and beyond. Hepatology. 2000; 31: 241–6PubMedCrossRef

37.

Boffa MJ, Chalmers RIG. Methotrexate for psoriasis. Clin Exp Dermatol. 1996; 21: 399–408PubMedCrossRef

38.

Gilmore IT, Burroughs A, Murray-Lyon IM, et al. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut. 1995; 36 (3): 437–41PubMedCrossRef

39.

Zachariae H, Søgaard H, Heickendorff L. Methotrexate-induced liver cirrhosis: clinical, histological and serological studies-a further 10-year follow-up. Dermatology. 1996; 192 (4): 343–6PubMedCrossRef

40.

Paul BS, Momtaz K, Stern RS, et al. Combined methotrexate-ultraviolet B therapy in the treatment of psoriasis. J Am Acad Dermatol. 1982; 7 (6): 758–62PubMedCrossRef

41.

van Dooren-Greebe RJ, Kuijpers AL, Termorshuizen F, et al. Interruption of longterm methotrexate treatment in psoriasis: evaluation of clinical course and laboratory parameters after discontinuation and reintroduction of weekly oral methotrexate. Acta Derm Venereol. 1995; 75 (5): 393–6PubMed

42.

van Dooren-Greebe RJ, Kuijpers AL, Buijs WC, et al. The value of dynamic hepatic scintigraphy and serum aminoterminal propeptide of type III procollagen for early detection of methotrexate-induced hepatic damage in psoriasis patients. Br J Dermatol. 1996; 134 (3): 481–7CrossRef

43.

Zachariae H, Aslam HM, Bjerring P, et al. Serum aminoterminal propeptide of type III procollagen in psoriasis and psoriatic arthritis: relation to liver fibrosis and arthritis. J Am Acad Dermatol. 1991; 25 (1): 50–3PubMedCrossRef

44.

Boffa MJ, Smith A, Chalmers RJ, et al. Serum type III procollagen aminopeptide for assessing liver damage in methotrexate-treated psoriatic patients. Br J Dermatol. 1996; 135 (4): 538–44PubMedCrossRef

45.

Zachariae H, Heickendorff L, Søgaard H. The value of amino-terminal propeptide of type III procollagen in routine screening for methotrexate-induced liver fibrosis: a 10-year follow-up. Br J Dermatol. 2001; 144 (1): 100–3PubMedCrossRef

46.

Rosenberg WM, Voelker M, Thiel R. On behalf of the European Liver Fibrosis Group. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology. 2004; 127: 1704–13PubMedCrossRef

47.

McHenry PM, Bingham EA, Callender ME, et al. Dynamic hepatic scintigraphy in the screening of psoriatic patients for methotrexate-induced hepatotoxicity. Br J Dermatol. 1992; 127 (2): 122–5PubMedCrossRef

48.

Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic spectroscopy study. Gut. 2005; 54: 122–7PubMedCrossRef

49.

Lim AKP, Patel N, Hamilton G, et al. The relationship of in vivo 31P MR spectroscopy to histology in chronic hepatitis C. Hepatology. 2003; 37: 788–94PubMedCrossRef

Title: Monitoring Liver Function during Methotrexate Therapy for Psoriasis
Are Routine Biopsies Really Necessary?
Authors: James A. Thomas
Dr Guruprasad P. Aithal
Publication date: 01-12-2005
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 6/2005
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.2165/00128071-200506060-00003

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Monitoring Liver Function during Methotrexate Therapy for Psoriasis

Are Routine Biopsies Really Necessary?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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