LIVER BIOPSIES FROM PSORIATICS RELATED TO METHOTREXATE THERAPY

Abstract

Results of post-MTX liver biopsies from 160 psoriatics treated with Methotrexate (MTX) in single, weekly, oral doses (25 mg maximum) are presented. Patients (92) with a single biopsy and 68 patients with serial biopsies were compared. At the time liver biopsy the 92 had received a mean cumulative Methotrexate dose of 2287 mg (range 50-5075 mg). One patient had cirrhosis and 6 had fibrosis. Comparing these 7 patients with patients having normal liver histology, 13 revealed no statistically significant difference in cumulative MTX doses but a statistically significant higher admitted alcohol intake during MTX therapy (P < 0.02) and an older age (P < 0.01) in the patients with cirrhosis or fibrosis. In the 68, MTX had accumulated to a mean dose of 3940 mg (range 325-8355 mg) at the time the latest liver biopsies were taken. Among the latest liver biopsies were 14 cirrhosis (21%, 95% confidence limits: 12-32%) and 16 fibrosis (24%, 95% confidence limits: 14-35%). The 14 with cirrhosis when compared to patients with normal histology (9), had taken an equal total MTX dose at the latest liver biopsy but had consumed a statistically significant higher alcohol amount (P < 0.05) during MTX therapy and tended to be older (P < 0.06). The prevalence of cirrhosis and fibrosis among MTX treated psoriatics increased rapidly beyond a cumultative dose of 2-4 MTX grams. No MTX treated psoriatics should be allowed to pass this dosage range without having a liver biopsy performed.