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Derm News: 2007.28(5)

Psoriasis patients with diabetes type 2 are at high risk of developing liver fibrosis during methotrexate treatment

Journal of Hepatolology, 46(6):1111-1118
Rosenberg, P.; Urwitz, H.; Johannesson, A.; Ros, A. M.; Lindholm, J.; Kinnman, N.; Hultcrantz, R
ABSTRACT

Background

We investigated the impact of diabetes mellitus type 2, overweight, alcohol over-consumption, and chronic hepatitis B or C as risk factors, for liver fibrosis in psoriasis patients treated with methotrexate.

Methods

One hundred and sixty-nine liver biopsies from 71 patients who underwent liver biopsies as part of the monitoring of methotrexate treatment for psoriasis were reviewed. Fibrosis, steatosis and inflammation were staged according to the NAFLD activity score.

Results

Twenty-six patients had one or more of the risk factors and 25 (96%) of these (median cumulative dose methotrexate 1500mg) developed liver fibrosis. Of those without risk factor, 26 (58%) (p=0.012) developed fibrosis (median cumulative dose methotrexate 2100mg). Ten (38%) of the patients with risk factor(s) had severe fibrosis (stage 3-4) (mean cumulative dose methotrexate 1600mg), while four (9%) (p=0.0012) of those without risk factors had severe fibrosis (median cumulative dose methotrexate 1900mg).

Conclusions

Methotrexate treated psoriasis patients with risk factors for liver disease, especially diabetes type 2 or overweight, are at higher risk to develop severe liver fibrosis and at a lower cumulative methotrexate dose given, compared to those without such risk factors.


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The Derm News service provided by the Editorial Consultants of Skin Therapy Letter© and its founding editor Dr. Stuart Maddin.