Monitoring liver function during methotrexate therapy for psoriasis: are routine biopsies really necessary?
Methotrexate is a widely used and efficacious treatment for psoriasis. Current recommendations advise liver biopsy after each cumulative 1-1.5g dosage of methotrexate. Although studies of methotrexate hepatotoxicity in psoriasis are of variable quality, the evidence indicates that in patients with no risk factors for liver disease on long-term, low-dosage (<20mg), once-weekly methotrexate, liver biopsy is justified after an initial cumulative dosage of 4g. Advances in the non-invasive assessment of liver fibrogenesis may eventually further reduce the need for biopsy.
Thomas
James A
JA
Queen's Medical Centre, University Hospital, Nottingham, UK.
Aithal
Guruprasad P
GP
D001706:Biopsy; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000145:classification / Q000517:prevention & control*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy*; D012307:Risk Factors
D003879:Dermatologic Agents; D008727:Methotrexate