Comparison of noninvasive screening tools for hepatic fibrosis, association with methotrexate cumulative dose, and risk factors in psoriasis patients. Issue 1 (22nd November 2021)

• Record Type: Journal Article
• Authors: Lee, Janet H. M.; Loo, Chai Har; Tan, Wooi Chiang; Lee, Choon Kin; Jamil, Adawiyah; Khor, Yek Huan
• Is Part Of: Dermatologic therapy. Volume 35:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-11-22
• Subjects: APRI -- FIB‐4 -- Fibroscan® -- methotrexate -- psoriasis -- transient elastography; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/dth.15203
• Languages: English
• ISSNs: 1396-0296

Abstract

Abstract: Methotrexate (MTX) is a first‐line systemic psoriasis therapy with risk of liver fibrosis. Noninvasive tools for liver fibrosis screening are Fibroscan®, Fibrosis‐4 (FIB‐4) index, and aspartate aminotransferase‐to‐platelet ratio (APRI) index. To compare Fibroscan®, FIB‐4, and APRI in detecting fibrosis, determine association of fibrosis with MTX cumulative dose, and explore risk factors for fibrosis. A case–control study involving psoriasis patients aged ≥18 years with MTX cumulative dose ≥1 g, with age and sex‐matched MTX naïve psoriasis patients was performed. Noninvasive tools were used to assess liver fibrosis. Sixty‐one patients on MTX and 54 controls participated. Fibroscan® detected fibrosis in 22 (36.1%) patients on MTX compared to 11 (19.6%) controls ( p = 0.05). FIB‐4 predicted fibrosis in 13 (21.3%) patients on MTX and in 10 (17.9%) controls ( p = 0.64) while APRI diagnosed 7 (11.5%) versus 7 (12.5%), p = 0.65. No significant correlation between Fibroscan® assessed liver stiffness and MTX cumulative dose ( p = 0.47). Independent risk factors for liver fibrosis were MTX use with raised alanine aminotransferase (OR = 68.56, 95% CI 8.26; 568.86, p < 0.001), diabetes mellitus (OR = 30.35, 95% CI 7.52; 122.42, p < 0.001), and raised BMI (obese patients OR = 8.26, 95% CI 1.73–39.43, p = 0.02; overweight patients OR = 6.29, 95% CI 1.28–30.99, p = 0.01). Liver fibrosis occurred in both MTX naïve and MTX‐treated psoriasis patients. Fibroscan® detected higher prevalence of liver fibrosis compared to FIB‐4 and APRI. Cumulative MTX does not correlate with fibrosis severity. Fibroscan® is recommended prior to MTX therapy and at regular intervals especially among patients with diabetes and increased BMI.