Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. May 27, 2013; 5(5): 275-280
Published online May 27, 2013. doi: 10.4254/wjh.v5.i5.275
Prevalence and risk factors of methotrexate hepatoxicity in Asian patients with psoriasis
Chong Meng Yeo, Vui Heng Chong, Arul Earnest, Wei Lyn Yang
Chong Meng Yeo, Wei Lyn Yang, Department of Gastroenterology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Vui Heng Chong, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam
Arul Earnest, Clinical Research Unit, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Yeo CM and Yang WL conceived the idea of the study; Yeo CM collected that data; Chong VH and Earnest A analysed the data; Yeo CM and Chong VH wrote the manuscript; all authors read and approved the final manuscript; Yeo CM was the guarantor.
Correspondence to: Dr. Chong Meng Yeo, Department of Gastroenterology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Telephone: +65-693577897 Fax: +65-63573087
Received: February 6, 2013
Revised: April 1, 2013
Accepted: May 7, 2013
Published online: May 27, 2013

AIM: To establish the prevalence of liver fibrosis and to evaluate the possible risk factors for fibrosis and progression in Asian with psoriasis treated with methotrexate (MTX) based on liver histology.

METHODS: Patients with psoriasis treated with MTX referred to the Department of Gastroenterology, Tan Tock Seng Hospital for liver biopsy were identified and retrospectively studied. Patient case notes and electronic records were retrieved from the hospital database and relevant data collated. Histological changes of liver biopsies were staged according to Roengik score. The factors assessed were age, gender, ethnicity, cumulative dose of MTX, presence of comorbid conditions such as diabetes, hypertension, hyperlipidemia, and ethanol use. We also assessed the histological change in those with multiple liver biopsies. Statistical analysis was performed using Stata V.9.2.

RESULTS: There were altogether 59 patients (median age 50 years old, range 22-81 years old, male, 88%) with 98 biopsies liver biopsies; 6 normal [median cumulative dose (MCD), 2285 mg]; 62 grade I (MCD 2885 mg), 23 grade II (MCD 1800 mg) and 7 grade III (MCD 1500 mg). There was no grade IV or cirrhosis. The prevalence of liver fibrosis (grade III) was 12%. Of the factors assessed, diabetes (P = 0.001) and hypertension (P = 0.003) were significant for fibrosis on univariate analysis but not on multivariate analysis. Of the 26 patients who had more than one biopsy (median 2, range 2-6), 57.7% (n = 15) were stable, 34.6% (n = 9) had progression and 7.7% (n = 2) had regression of histological grades. On univariate analysis, non-Chinese ethnicity (P = 0.031), diabetes (P = 0.018), and hyperlipidemia (P = 0.011) were predictive of progression of grades, but these were not significant on multivariate analysis.

CONCLUSION: Liver fibrosis in Asian psoriatic population on MTX is comparable to the West. Cumulative dose was not associated with liver fibrosis. Metabolic syndrome is important factors.

Keywords: Hepatotoxicity, Liver fibrosis, Methotrexate, Risk factors, Cirrhosis

Core tip: Old studies have shown that the prevalence of methotrexate (MTX) associated liver fibrosis and cirrhosis to be as high as 50% and 26% respectively. Later studies have shown that the risk is much lower than previously reported. These studies have been based on western patients. To date, there is no study that had assessed MTX hepatotoxicity in Asian patient based on liver histology. This study showed that the risk of methotrexate hepatoxicity in Asian patients with psoriasis is also low and progression is minimal. We showed that ethnicity and presence of diabetes and hyperlipidemia, part of the metabolic syndrome may be important factors.