Methotrexate in psoriasis with and without leucovorin: effect of different dosage schedules on acute liver toxicity

Area of Science:

• Dermatology
• Hepatology
• Pharmacology

Background:

• Psoriasis is a chronic inflammatory skin condition.
• Methotrexate is a common treatment for psoriasis.
• Assessing liver toxicity is crucial for methotrexate therapy.

Purpose of the Study:

• To evaluate the acute liver toxicity of different intermittent methotrexate dosage schedules.
• To determine the impact of leucovorin addition on methotrexate-induced liver toxicity.
• To assess liver safety in psoriatic erythroderma patients receiving high-dose methotrexate with leucovorin rescue.

Main Methods:

• Thirty-six psoriatic patients were studied.
• Four different intermittent methotrexate dosage schedules were compared.
• Leucovorin was administered with or without methotrexate.
• Serum Glutamic Oxaloacetic Transaminase (SGOT) levels were monitored daily for one week.
• Three patients with psoriatic erythroderma received high-dose (100 mg i.v.) methotrexate with leucovorin rescue.

Main Results:

• No significant differences in acute liver toxicity were observed across the four methotrexate dosage schedules.
• The addition of leucovorin did not alter the acute liver toxicity profile.
• High-dose methotrexate (100 mg i.v.) with leucovorin rescue in psoriatic erythroderma patients showed comparable acute liver toxicity.
• All patients tolerated the treatment well with no distinct adverse liver events.

Conclusions:

• Intermittent methotrexate dosage schedules, with or without leucovorin, appear to have similar acute liver safety profiles in psoriatic patients.
• High-dose methotrexate with leucovorin rescue is a viable treatment option for psoriatic erythroderma with acceptable acute liver toxicity.
• Close monitoring of liver function, such as SGOT levels, remains important during methotrexate therapy.