Risk of Liver Fibrosis in Methotrexate-Treated Patients: A Systematic Review

Area of Science:

• Rheumatology
• Hepatology
• Pharmacology

Background:

• Methotrexate (MTX) is a primary disease-modifying antirheumatic drug (DMARD).
• Concerns exist regarding potential MTX-induced liver toxicity, specifically fibrosis.
• Understanding MTX's impact on liver health is crucial for patient management.

Purpose of the Study:

• To systematically review liver fibrosis in patients treated with MTX.
• To evaluate the relationship between MTX treatment duration, cumulative dose, and liver fibrosis.
• To identify differences in liver fibrosis based on underlying rheumatic diseases.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Searched PubMed, PMC, and Cochrane Library for relevant studies (last 20 years).
• Included systematic reviews, observational studies, RCTs, and clinical trials; assessed study quality.

Main Results:

• Ten studies (8 observational, 2 systematic reviews) were included.
• Liver enzyme elevations are common but typically transient.
• MTX-associated liver fibrosis is uncommon, despite potential associations with serial abnormal liver enzyme tests.

Conclusions:

• MTX-induced liver fibrosis is uncommon.
• The link between MTX and liver toxicity requires further investigation.
• Optimal management strategies for elevated liver enzymes during MTX therapy remain unclear, necessitating more research.