Hepatotoxicity rates do not differ in patients with rheumatoid arthritis and psoriasis treated with methotrexate

Abstract

Our study did not corroborate previous findings of significant differences between psoriasis patients and RA patients concerning susceptibility to hepatotoxicity from MTX therapy. The only significant factor predicting a higher risk of hepatic damage was female gender.

Assessment of liver fibrosis with transient elastography and FibroTest in patients treated with methotrexate for chronic inflammatory diseases: A case–control study

“…For this reason, we chose cut-offs published in patients with NASH which have good negative predictive value to exclude significant fibrosis [18]. Abnormal liver function tests are commonly observed in patients treated with methotrexate for various benign diseases [41]. Elevated ALT ranged from 6% in Crohn's disease patients [42] to 73% in psoriasis patients [43].…”

Risk of liver injury among methotrexate users: A meta-analysis of randomised controlled trials

“…The inclusion criteria for study selection were [1] double-blind randomised controlled trials; [2] human subjects; [3] patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, or inflammatory bowel disease; [4] studies in English; [5] studies consisting of a minimum of two arms, at least one receiving methotrexate and at least one not receiving methotrexate; [6] studies including only adults (≥18 years); [7] trials of ≥24 weeks duration; [8] studies of ≥100 patients; [9] studies reporting liver adverse events for methotrexate and comparator groups separately. In the case of multiple publications of one randomised controlled trial we included the publication most relevant to our inclusion criteria, in terms of detailed reporting of liver adverse events.…”

“…Sensitivity analyses were performed to assess, [1] disease [2] the effect of trial size on meta-analysis outcome (trials of <500 participants versus trials of ≥500 participants), [3] the effect of excluding studies which reported safety data by means other than intention-to-treat, [4] the effect of comparator drug (biologic agents, other immunosuppressants, placebo), [5] methotrexate naivety, [6] the effect of folate supplementation, [7] methotrexate dosage, [8] trials specifying alcohol use as an exclusion criteria, [9] trials specifying baseline liver disease or abnormal liver enzymes as an exclusion criteria.…”

“…Others have suggested the incidence varies between different diseases, but some do not support this concept (8,9). Recent reviews suggest weekly dosing in appropriately selected patients rarely leads to serious toxicity (1,(5)(6)(7)10).…”

Histopathological Features of Methotrexate Induced Pulmonary Lesions in Rheumatoid Arthritis Patients: A Systematic Review of Case Reports

“…The most prevalent induced MTX pulmonary complication is the acute hypersensitivity pneumonitis [5]. It is estimated that acute pulmonary toxicity develops in about 12.5% of patients on methotrexate therapy for all rheumatic conditions, including rheumatoid arthritis, but other studies suggest an incidence as high as 33% [6, 7]. Table 1 lists the major and the minor criteria for the diagnosis of MTX-induced pulmonary complication in rheumatoid arthritis patients, and how definite or probable cases are diagnosed [8].…”