Assessment of liver fibrosis with transient elastography and FibroTest in patients treated with methotrexate for chronic inflammatory diseases: a case-control study.
OBJECTIVE
Although methotrexate (MTX) is used in the effective treatment of inflammatory disorders, its use is hampered by the risk of liver fibrosis. Non-invasive methods for the diagnosis of liver fibrosis, such as transient elastography (FibroScan) and FibroTest could be useful for monitoring MTX-liver toxicity. The aim of this case-control study was to determine factors associated with liver fibrosis in a large cohort of patients requiring MTX.


METHODS
Consecutive adults with various benign inflammatory diseases were prospectively assessed using FibroScan and FibroTest when they were treated with MTX (cases) or before beginning treatment (controls).


RESULTS
Among 518 included patients, 44 patients (8.5%) had FibroScan and/or FibroTest results suggesting severe liver fibrosis. In a multivariate analysis, factors associated with abnormal markers of liver fibrosis were the body mass index >28 kg/m(2) and high alcohol consumption. Neither long MTX duration nor cumulative doses were associated with elevated FibroScan or FibroTest results.


CONCLUSIONS
Severe liver fibrosis is a rare event in patients treated with MTX and is probably unrelated to the total dose. Patients with other risk factors for liver disease should be closely monitored with non-invasive methods before and during MTX treatment.
Laharie
David
D
Inserm U853, Univ Bordeaux 2, Bordeaux F-33076, France.
Seneschal
Julien
J
Schaeverbeke
Thierry
T
Doutre
Marie-Sylvie
MS
Longy-Boursier
Maïté
M
Pellegrin
Jean-Luc
JL
Chabrun
Edouard
E
Villars
Sandrine
S
Zerbib
Frank
F
de Lédinghen
Victor
V
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D008103:Liver Cirrhosis / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008727:Methotrexate