Low incidence of hepatotoxicity associated with long-term, low-dose oral methotrexate in treatment of refractory psoriasis, psoriatic arthritis, and rheumatoid arthritis: an acceptable risk/benefit ratio

Thirty patients with psoriasis or other nonmalignant diseases had liver biopsies done before treatment with low-dose methotrexate, 15 mg/week, and then at one- to two-year intervals as long as they continued the methotrexate. All patients were symptomatically improved on this regimen. The 15 patient...

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Published in:Digestive diseases and sciences 1985-02, Vol.30 (2), p.104-109
Main Authors: LANSE, S. B, ARNOLD, G. L, GOWANS, J. D. C, KAPLAN, M. M
Format: Article
Language:English
Subjects:
Adult
Aged
Alcohol Drinking
Arthritis - drug therapy
Arthritis, Rheumatoid - drug therapy
Biological and medical sciences
Biopsy
Chemical and Drug Induced Liver Injury
Female
Humans
Liver - drug effects
Liver - pathology
Liver Diseases - pathology
Male
Medical sciences
Methotrexate - administration & dosage
Methotrexate - adverse effects
Methotrexate - therapeutic use
Middle Aged
Pharmacology. Drug treatments
Prospective Studies
Psoriasis - drug therapy
Skin, nail, hair, dermoskeleton
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Summary:Thirty patients with psoriasis or other nonmalignant diseases had liver biopsies done before treatment with low-dose methotrexate, 15 mg/week, and then at one- to two-year intervals as long as they continued the methotrexate. All patients were symptomatically improved on this regimen. The 15 patients who had normal liver biopsies at the start of the study had normal biopsies after methotrexate. Fifteen others had minor hepatic histologic abnormalities before treatment. Eleven patients had fatty infiltration. Ten showed no significant change after treatment while one had increased fat and portal fibrosis on a fourth liver biopsy done seven years after MTX was begun. This last patient, a former alcohol abuser, continued methotrexate and showed no further worsening at 8 years. The remaining four had portal fibrosis before treatment. One patient had less fibrosis after methotrexate, two patients slightly more fibrosis, and one a marked increase in portal fibrosis. No patient developed cirrhosis or clinical liver disease. Our results suggest that in the absence of alcohol consumption, low-dose weekly methotrexate treatment rarely causes clinically significant liver damage.
ISSN:0163-2116
1573-2568
DOI:10.1007/BF01308193