Dangers of Methotrexate/Etretinate Combination Therapy

Pityriasis rubra pilaris

“…Eight of the 11 showed 50% or greater response at 16 weeks of treatment. Although combination therapy was well tolerated in this series, it should be used with caution because of the risk of toxic hepatitis 136 , 137 . In one report, severe drug‐induced hepatitis occurred in two of 10 patients receiving combination therapy for psoriasis 137 .…”

“…Although combination therapy was well tolerated in this series, it should be used with caution because of the risk of toxic hepatitis 136 , 137 . In one report, severe drug‐induced hepatitis occurred in two of 10 patients receiving combination therapy for psoriasis 137 . Dosages should be minimized, and frequent clinical and laboratory evaluation of patients, including weekly liver function test monitoring for the first 6–8 weeks, is recommended.…”

Psoriasis and the liver: problems, causes and course

“…Overall, 57% of abnormal LFT was associated with medications and most commonly with MTX, which was responsible for 56% of drug‐induced hepatotoxicity. Although nearly all antipsoriatic medications are potentially hepatotoxic, MTX is the most important as it may cause hepatic fibrosis . Given the fact that MTX liver toxicity is more common in the setting of NAFLD and coexistent PsA, possibly through prolonged inflammation and multiple drug exposure, patients with metabolic syndrome using MTX should be closely monitored in routine dermatology practice.…”

“…In addition to NAFLD, drug‐induced hepatitis, alcoholic hepatitis and, rarely, neutrophilic cholangitis are the other liver diseases seen in psoriasis. The drugs used in the management of psoriasis and its comorbidities, especially methotrexate (MTX), acitretin, and rarely biological agents and statins may also cause toxic hepatitis . The existence of NAFLD and other liver problems is an important challenge in treatment as it necessitates more carefully monitoring the patients.…”

Clinical experience of combination therapy of infliximab and total glucosides of paeony for severe psoriasis with liver disorder history

“…Liver function is the major concern when selecting the optimal treatment in those patients. Systemic drugs such as MTX, acitretin and even biological agents are reported to cause liver test abnormalities [13][14][15] . In our clinical study, patients were treated with combination therapy of infliximab and TGP.…”