Methotrexate and liver function: a study of 13 psoriasis cases treated with different cumulative dosages.
BACKGROUND
The need and frequency of hepatic biopsies during methotrexate (MTX) therapy are still controversial.


OBJECTIVE
The purpose of this investigation is to assess MTX liver toxicity in patients with psoriasis through percutaneous liver biopsy, and compare liver morphology changes with increasing cumulative dosages (1, 2, 3 and 4 g) of MTX.


RESULTS
Cumulative dosages of 1 to 2 g MTX did not cause significant liver toxicity. From a cumulative dosage of 3 to 4 g, there is fibrosis formation, inflammation enhancement in the portal area and fibrous septa, configuring regenerative nodes.


CONCLUSIONS
In patients with no risk factors for liver disease, with normal physical examination and liver tests, biopsy can be done after a cumulative MTX dosage of approximately 1 to 1.5 g and repeated for each gram. In patients with risk factors, liver biopsy should be done before use of MTX, or within the first 2 months of treatment at the most, and repeated for each gram of cumulative dosage.
Carneiro
S C
SC
Sector of Dermatology and Post Graduation Course, HUCFF/URFJ and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Cássia
F F
FF
Lamy
F
F
Chagas
V L A
VL
Ramos-e-Silva
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D022781:Hepatocytes / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D012307:Risk Factors
D003879:Dermatologic Agents; D008727:Methotrexate