Does Methotrexate Increase Cirrhosis Risk for Psoriatic Patients with Chronic Hepatitis?
Liver cirrhosis is a concern for patients with psoriasis that are treated long-term with methotrexate (MTX). Previous studies have shown that patients with psoriasis who received long-term MTX were more likely to develop severe liver fibrosis or cirrhosis. Based on this data, a recent study from Taiwan sought to explore the effects of MTX on psoriasis patients who also have chronic viral hepatitis to determine if long-term MTX use would similarly increase their risk of liver cirrhosis.
The authors used a retrospective cohort study to identify 2,417 patients with chronic hepatitis B (CHB) and incident psoriasis, and 1,127 patients with chronic hepatitis C (CHC) and incident psoriasis. The authors looked at the baseline characteristics of psoriatic patients with chronic viral hepatitis and the risk factors of those who did develop cirrhosis.
The results showed that patients with chronic viral hepatitis who were on long-term MTX treatment were not at greater risk for developing cirrhosis. After a follow-up period of an average 9 years after the diagnosis of chronic viral hepatitis, about 5% of patients with CHB and 11% of patients with CHC developed liver cirrhosis. Approximately the same proportion of MTX users and nonusers of MTX developed liver cirrhosis and there was also no significant difference in liver cirrhosis free survival between MTX users and nonusers.
The authors conclude that because long-term MTX use is not associated with an increased risk of liver cirrhosis among psoriatic patients with chronic viral hepatitis, MTX may be a treatment option for this population.