Evaluation of liver fibrosis by transient elastography (Fibroscan®) in patients with inflammatory bowel disease treated with methotrexate: a multicentric trial.
BACKGROUND
Methotrexate is an effective treatment for inflammatory bowel disease (IBD). However, long-term treatments have been associated with the development of liver fibrosis. FibroScan® is a noninvasive, safe, and effective technique to evaluate liver fibrosis.


OBJECTIVE
To evaluate the presence of significant liver fibrosis by transient elastography (FibroScan®) in IBD patients treated with methotrexate.


METHODS
Cross-sectional study including IBD patients treated with methotrexate from different hospitals. Clinical and analytical data, duration of treatment, and cumulative dose of methotrexate were obtained. Liver stiffness was assessed by FibroScan®. The cutoff value for significant liver fibrosis (according to METAVIR) was F ≥ 2: 7.1 kPa. Results. In the study, 46 patients were included, 30 women (65%), with a mean age of 43 ± 10 years. 31 patients had Crohn's disease (67.4%), 13 ulcerative colitis (28.3%), and 2 indeterminate colitis (4.3%). The mean cumulative dose of methotrexate was 1242 ± 1349 mg, with a mean treatment duration of 21 ± 24 months. The mean value of liver stiffness was 4.7 ± 6.9 kPa. There were 35 patients (76.1%) with F01, 8 patients (17.4%) with F = 2, and 3 patients with F ≥ 3 (6.5%). There were no differences in liver stiffness depending on sex, age, type of IBD, or cumulative dose of methotrexate.


CONCLUSIONS
(1) Development of advanced liver fibrosis in IBD patients treated with methotrexate is exceptional. (2) There were no differences in liver stiffness depending on the type of IBD or the cumulative dose of methotrexate. (3) FibroScan® may be potentially useful for evaluation and follow-up of liver fibrosis in methotrexate-treated patients.
Instituto de Investigación Sanitaria Princesa-IP and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas-CIBEREHD, Universitario de La Princesa, Gastroenterology Units of the Hospitals, Madrid, Spain.
A
A
Barbero-Villares
J
J
Mendoza Jiménez-Ridruejo
C
C
Taxonera
A
A
López-Sanromán
R
R
Pajares
F
F
Bermejo
J L
JL
Pérez-Calle
J L
JL
Mendoza
A
A
Algaba
R
R
Moreno-Otero
J
J
Maté
J P
JP
Gisbert
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged
D007166:Immunosuppressive Agents; D008727:Methotrexate