Analysis of Risk Factors in Psoriatic Patients With Methotrexate-Induced Increases in Transaminase Levels

Conventional Therapies for Psoriasis

“…It is important to ensure that a psoriasis "flare" is not due to an undiagnosed concomitant disease affecting immune response (3). In fact, no prospective, randomized, placebo controlled trials have ever been published, but an active controlled study which compares methotrexate with cyclosporine (4). In this study, methotrexate proved to be poorly tolerated in that about 1 / 4 of patients had to discontinue it because of elevation of transaminases.…”

Real-life experience of using conventional disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA). Retrospective analysis of the efficacy of methotrexate, sulfasalazine, and leflunomide in PsA in comparison to spondyloarthritides other than PsA and literature review of the use of conventional DMARDs in PsA

“…In some cases a liver biopsy may be recommended (41). Male gender and increased age have also been found to be associated with an increased risk of increases in transaminases (42), whereas supplementation with folic acid reduces abnormalities in liver function with no effect on efficacy in RA (43). The same regime of folic acid is recommended for PsA.…”

Análisis del resultado de pruebas hepáticas en pacientes psoriáticos tratados con metotrexato: Estudio retrospectivo

“…Se ha reportado que el riesgo relativo de aumento de transferasas en hombres psoriáticos tratados con metotrexato es de 2,7 (CI 95%, 0,7-10,7), para pacientes mayores de 40 años es de 1,7 (CI 95%, 0,6-4,9), y en ausencia de esteatohepatitis previa es de 0,8 (CI 95%, 0,3-2,8) 21 .…”

“…En Europa, 20% de los dermatólogos lo usa rutinariamente para la detección de fibrosis hepática secundaria a metotrexato 9 , lo que lleva a que la monitorización con pruebas hepáticas se realice más espaciada, esto es cada 2 meses o más. Se recomienda controlar niveles de PIIIP cada 3 meses durante un tratamiento continuo de metotrexato 28,29 , con indicación de biopsia, sólo en caso de niveles persistentemente altos 21 . Esto ha logrado disminuir 7 veces la necesidad de biopsia hepática en paciente psoriáticos tratados con metotrexato, con un costo menor y la preferencia de los pacientes 26 .…”