Liver fibrosis screening for patients with psoriasis taking methotrexate: a cross‐sectional study comparing transient elastography and liver biopsy

Bray, Adam; Barnova, I; Przemioslo, Robert; Kennedy, C. T. C.

doi:10.1111/j.1365-2133.2011.10657.x

Cited by 24 publications

(28 citation statements)

References 12 publications

(16 reference statements)

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“…However, in our sample, PIIINP testing is not commonly done. Transient elastography is another tool that provides good information about liver status and when combined with biomarkers, appears to have the potential to reduce the number of liver biopsies required for safe MTX monitoring in patients with psoriasis …”

Section: Discussionmentioning

confidence: 99%

“…Transient elastography is another tool that provides good information about liver status and when combined with biomarkers, appears to have the potential to reduce the number of liver biopsies required for safe MTX monitoring in patients with psoriasis. 13,14 Monitoring myelosuppression Myelosuppression (leukopenia, thrombocytopenia, and anemia) is the main side effect of MTX, which is dosedependent and life threatening. Because of the risk of this potential hematologic toxicity, an initial test dose of MTX is indicated.…”

Section: Monitoring Hepatotoxicitymentioning

confidence: 99%

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Considerable variation among Iranian dermatologists in the dosing and monitoring of methotrexate for treating psoriasis

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Section: Monitoring Hepatotoxicitymentioning

confidence: 99%

Considerable variation among Iranian dermatologists in the dosing and monitoring of methotrexate for treating psoriasis

et al. 2013

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“…Other studies have reported the accuracy of TE in patients with CLD related to etiologies other than CHB and CHC 36-46. First, the role of TE was investigated in patients with hepatitis C and HIV co-infection 36,40-42.…”

Section: Diagnostic Performance Of Assessing Liver Fibrosismentioning

confidence: 99%

“…Although the diagnostic accuracy was considerable (AUROC, range 0.81-0.95 for significant fibrosis and 0.91-0.96 for cirrhosis), its usefulness requires further validation. Interestingly, recent studies have suggested the ability of TE to assess fibrosis stage in patients taking methotrexate with potential hepatotoxicity due to rheumatoid arthritis, inflammatory bowel disease, or psoriasis 39,45,46…”

Section: Diagnostic Performance Of Assessing Liver Fibrosismentioning

confidence: 99%

Clinical applications of transient elastography

2012

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Chronic liver disease represents a major public health problem, accounting for significant morbidity and mortality worldwide. As prognosis and management depend mainly on the amount and progression of liver fibrosis, accurate quantification of liver fibrosis is essential for therapeutic decision-making and follow-up of chronic liver diseases. Even though liver biopsy is the gold standard for evaluation of liver fibrosis, non-invasive methods that could substitute for invasive procedures have been investigated during past decades. Transient elastography (TE, FibroScan®) is a novel non-invasive method for assessment of liver fibrosis with chronic liver disease. TE can be performed in the outpatient clinic with immediate results and excellent reproducibility. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis; as a result, unnecessary liver biopsy could be avoided in some patients. Moreover, due to its excellent patient acceptance, TE could be used for monitoring disease progression or predicting development of liver-related complications. This review aims at discussing the usefulness of TE in clinical practice.

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“…52,53 Another new technique, the Controlled Attenuation Parameter (CAP; Echosens) has been shown to be very sensitive in detecting early steatosis. 54 Bray et al 55 reported that transient elastography combined with PIIINP has the potential to reduce the number of liver biopsies required for safe MTX monitoring in patients with psoriasis (particularly for those with a body mass index of < 30 kg/m 2 ). Montaudie et al 31 proposed that a combination of fibrotests and fibroscans together with measurement of the PIIINP is an ideal method for monitoring liver toxicity.…”

Section: Adverse Effectsmentioning

confidence: 99%

Systemic methotrexate therapy for psoriasis: past, present and future

Dogra

Mahajan

2013

Clin Exp Dermatol

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Methotrexate (MTX) has remained the backbone of the treatment for moderate to severe psoriasis ever since its first use nearly half a century ago. Over the years, its high efficacy, low cost, relative ease of administration and usefulness in concomitant psoriatic arthritis have contributed in making MTX the drug of choice in managing severe psoriasis. Although the majority of patients achieve remission of disease activity with MTX, a significant proportion may experience mild and transient adverse effects. From time to time, various guidelines on the use of MTX have correctly and adequately stressed the need for strict monitoring of haematological and hepatic adverse events. Over the years, the safe total cumulative dose of MTX (above which the risk of developing liver fibrosis is significantly increased) has been raised. Simultaneously, there has been an increased emphasis on developing noninvasive tests such as scanning and serum biomarker assays for detecting early liver fibrosis, in order to obviate the need for liver biopsy. However, the recent discovery and subsequent proliferating use of biological response modifiers has gradually shifted the focus away from MTX, despite it still being the most commonly prescribed drug for psoriasis worldwide. The aim of this review is to present a detailed account of MTX therapy and its use in psoriasis, along with its current relevance in disease management in the evolving era of biological drugs.

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Liver fibrosis screening for patients with psoriasis taking methotrexate: a cross‐sectional study comparing transient elastography and liver biopsy

Cited by 24 publications

References 12 publications

Considerable variation among Iranian dermatologists in the dosing and monitoring of methotrexate for treating psoriasis

Considerable variation among Iranian dermatologists in the dosing and monitoring of methotrexate for treating psoriasis

Clinical applications of transient elastography

Systemic methotrexate therapy for psoriasis: past, present and future

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