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

Howard Amital1, Yoav Arnson, Gabriel Chodick

  • 1Department of Medicine D, Meir Medical Center, Kefar Saba, Israel. howard.amital@clalit.org.il

Rheumatology (Oxford, England)
|July 7, 2009
PubMed
Abstract

Insights

Methotrexate (MTX) hepatotoxicity risk did not differ between rheumatoid arthritis (RA) and psoriasis patients. Female gender and higher cumulative MTX dose were the only significant predictors of liver damage in this long-term study.

Area of Science:

  • Pharmacology
  • Hepatology
  • Rheumatology

Background:

  • Methotrexate (MTX) is a common treatment for rheumatoid arthritis (RA) and psoriasis.
  • Concerns exist regarding MTX-induced hepatotoxicity, particularly in psoriasis patients compared to RA patients.
  • Existing toxicity guidelines are based on limited data from small studies with short follow-up periods.

Purpose of the Study:

  • To investigate the long-term risk of MTX hepatotoxicity in patients with RA and psoriasis.
  • To compare the incidence and risk factors of MTX hepatotoxicity between these two patient populations.

Main Methods:

  • Retrospective cohort review of patients with RA (n=119) or psoriasis (n=690) who purchased MTX.
  • Serial liver function analyses were conducted and recorded in a health maintenance organization's database.
  • Statistical analysis identified pre-disposing factors for liver damage.

Main Results:

  • Both RA and psoriasis patients experienced hepatic enzyme elevation during MTX therapy.
  • Female gender (HR, 1.46) and higher cumulative MTX dose (HR, 1.07) were significant predictors of liver damage (P < 0.001).
  • No statistically significant difference in liver function test abnormalities was found between RA and psoriasis patients.

Conclusions:

  • The study did not find significant differences in MTX hepatotoxicity susceptibility between psoriasis and RA patients.
  • Female gender emerged as the sole significant predictor of increased hepatic damage risk.
  • Findings suggest current toxicity guidelines may need re-evaluation based on long-term data.

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