Arch Dermatol. 1970 Dec;102(6):613-8. Evaluation of possible chronic hepatotoxicity from methotrexate for psoriasis. Weinstein GD, Cox JW, Suringa DW, Millard MM, Kalser M, Frost P. Liver status in 29 psoriatic patients, eight before methotrexate treatment and 21 after methotrexate therapy (three weeks to ten years), was evaluated by performing routine liver function tests, a test for sulfobromophthalein (Bromsulphalein) (BSP) retention, and liver biopsy. The most common side effects associated with the use of(MTX) in doses commonly used to treat rheumatic diseases (particularly rheumatoid arthritis RA ) are not life-threatening. Hepatotoxicity associated with chronic low-dose methotrexate for nonmalignant disease. MTX hepatotoxicity in patients with psoriasis appears to increase with the total cumulative dose 6.
Et al, The place of type III procollagen aminopeptide measurement in the assessment of liver disease in methotrexate-treated psoriasis patients. Et al, Methotrexate accumulation and folate depletion in cells as a possible mechanism of chronic toxicity to the drug. A review of the liver biopsy specimens showed no statistically significant differences in the histologic changes between the treated and untreated patients. Evaluation of possible chronic hepatotoxicity from methotrexate for psoriasis. A premethotrexate evaluation is important to ensure proper patient selection for this effective but potentially toxic drug. Abnormal liver histology appears to be more common in patients with psoriasis than in those with rheumatoid arthritis. 7 Patients may experience a range of liver problems from mild fatty infiltrate to moderate or severe fibrosis, necrosis and cirrhosis.8 Hepatotoxic effects are associated with long-term use and high doses of methotrexate and are common in patients taking a daily dose, which is never advisable.
With the small but chronic doses used for psoriasis, methotrexate has been relatively safe, except for a limited occurrence of significant hepatotoxicity. Evaluation of possible chronic hepatotoxicity from methotrexate for psoriasis. Because of the potential hepatotoxicity of methotrexate, we suggest that a prospective, randomized trial be done. P. Evaluation of possible chronic hepatotoxicity from methotrexate for psoriasis. Edmudson, W.F., Guy, W.B. Treatment of psoriasis with folic acid antagonist.
References In Methotrexate Hepatotoxicity
Review of the literature demonstrates cases of this important rare adverse event, primarily occurring in patients with chronic plaque psoriasis, induced by triggers such as accidental overdose or introduction of an interacting agent. Methotrexate is licensed for the treatment of severe psoriasis, psoriatic arthritis, rheumatoid arthritis, and a number of malignancies, including: childhood acute lymphoblastic leukemia, lymphoproliferative disorders, choriocarcinoma, and various solid organ tumors. Monitoring for liver toxicity may include regular serum liver function testing, serial measurement of procollagen III peptide, liver biopsy, and/or transient elastography scanning 33, although robust evidence to support the utility of one or more potential biomarkers of liver toxicity is lacking. Although there are only two small controlled trials evaluating methotrexate for psoriatic arthritis that are inadequately powered to assess clinical benefit,176,177 methotrexate is often used as the primary agent to treat psoriatic arthritis. Methotrexate versus cyclosporine in moderate-to-severechronic plaque psoriasis. Doses can be increased gradually until an optimal response is achieved; total dose should not ordinarily exceed 30 mg/wk; doses should be reduced to the lowest possible amount of drug needed to achieve adequate control of psoriasis with concomitant topical therapy. Noninvasive monitoring for methotrexate hepatotoxicity. What are the Common Adverse Effects of Methotrexate? Fallacies of Liver Biopsy Reporting The Psoriasis Task Force developed the Roenigk classification for monitoring of methotrexate-induced liver injury; however, this scale has never been validated or used in the evaluation of any other liver disease as it is very subjective and insensitive to small changes, particularly when assessing fibrosis.