A new noninvasive approach to assessment for patients receiving methotrexate therapy might reduce the number of liver biopsies.
A noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis, the NASH FibroSure test, can be used to monitor changes in fibrosis score in patients who have psoriasis and are receiving long-term methotrexate therapy, a recent study showed.
Researchers suggested that the long-term implications of hepatotoxic effects in patients with psoriasis remained uncharacterized and a method for noninvasive monitoring was needed.
So they evaluated whether NASH FibroSure can be used for patients with psoriasis to help determine their eligibility for methotrexate sodium therapy and monitor for the development of methotrexate-induced hepatotoxic effects and for worsening of hepatic fibrosis scores during therapy.
The investigators conducted a retrospective descriptive analysis among a cohort of patients with psoriasis treated with methotrexate who underwent NASH FibroSure testing.
• The prevalence of elevated hepatic steatosis scores was high in the patients with psoriasis in this study.
• A statistically significant correlation between worsening fibrosis scores and cumulative methotrexate dose was observed in women, but not in men.
• The correlation for women remained significant after correcting for patients who had multiple NASH FibroSure tests.
• There was a statistically significant correlation between a body mass index (BMI) of 28 or more and worsening fibrosis scores for women.
• There was no significant correlation between the combination of age older than 65 years and worsening of hepatic fibrosis scores with cumulative methotrexate dose.
• There were no differences between men and women with regard to prevalence of a BMI of 28 or more, diabetes, age older than 65 years, or chronic kidney disease.
• These results suggest that for women, obesity influences the progression of fibrosis scores.
NASH FibroSure may be used to help monitor for risk of worsening fibrosis during methotrexate therapy, especially among female patients, the authors concluded. The results do not suggest that a liver biopsy can be replaced by the NASH FibroSure test, they pointed out, but they do support the idea that the use of noninvasive tests such as the NASH FibroSure can significantly reduce the number of liver biopsies.
The researchers reported their findings in JAMA Dermatology.
Bauer B, Chyou PH, Stratman EJ, Green C. “Noninvasive Testing for Nonalcoholic Steatohepatitis and Hepatic Fibrosis in Patients With Psoriasis Receiving Long-term Methotrexate Sodium Therapy.” JAMA Dermatol. 2017 Aug 23. doi: 10.1001/jamadermatol.2017.2083. [Epub ahead of print]