title: The use of transient elastography and FibroTest for monitoring hepatotoxicity in patients receiving methotrexate for psoriasis.
abstract: OBJECTIVE
  There is a need for noninvasive tools to monitor hepatotoxicity in patients with psoriasis who are receiving methotrexate sodium.
  
  
  OBJECTIVE
  To evaluate the use of transient elastography (TE) and FibroTest (FibroSURE in the United States), an indirect serum marker of fibrosis, in this population.
  
  
  METHODS
  Patients receiving methotrexate therapy for psoriasis between January 2008 and September 2009 were recruited from a dermatology outpatient department. Transient elastography and FibroTest were performed, and patients with abnormal results were considered for liver biopsy. Serial procollagen III peptide (PIIINP) results were recorded.
  
  
  METHODS
  Transient elastography uses pulse-echo ultrasonography to measure liver stiffness, and this result is an indirect measure of hepatic fibrosis. FibroTest is an indirect serum marker of hepatic fibrosis.
  
  
  METHODS
  Procollagen III peptide, TE, and FibroTest results, as well as the need for liver biopsy in this cohort.
  
  
  RESULTS
  Seventy-seven patients (41 male [53%]) were included. Fifty (65%) patients had a valid TE assessment, and 9 (18%) had an abnormal result (range, 7.1-11.3 kPa). Being overweight or obese increased the possibility of obtaining an invalid TE result significantly (P = .01). On univariate analysis body mass index (r = 0.40, P = .005) and age (r = 0.52, P = .005) were correlated with abnormal TE results. Seventy-one patients received a FibroTest and 11 of 70 analyzed (16%) had an abnormal result (METAVIR score >F1). Age (r = 0.31, P = .009), cumulative methotrexate dose (r = 0.31, P = .01), and duration of methotrexate therapy (r = 0.36, P = .002) were correlated with abnormal FibroTest results. There was no correlation between PIIINP levels and TE results or between PIIINP levels and FibroTest results. Steatosis was demonstrated in all 5 patients who received liver biopsies during the study. Two patients had hepatic fibrosis, with 1 showing a sinusoidal pattern of fibrosis attributed to steatohepatitis.
  
  
  CONCLUSIONS
  Transient elastography and FibroTest are effective noninvasive tools for monitoring hepatotoxicity in patients receiving methotrexate for psoriasis. We propose that the need for liver biopsy could be reduced if abnormalities in at least 2 tests (serial PIIINP, TE, or FibroTest) are required before biopsy is considered. This strategy should be evaluated in prospective studies.
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Maeve
authors: M
authors: Lynch
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Eleanor
authors: E
authors: Higgins
authors: Liver Unit, St Vincent's University Hospital, Dublin, Ireland.
authors: P Aiden
authors: PA
authors: McCormick
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Brian
authors: B
authors: Kirby
authors: Histology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Niamh
authors: N
authors: Nolan
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Sarah
authors: S
authors: Rogers
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Aoife
authors: A
authors: Lally
authors: Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors: Akke
authors: A
authors: Vellinga
authors: Liver Unit, St Vincent's University Hospital, Dublin, Ireland.
authors: Haniza
authors: H
authors: Omar
authors: The Charles Centre, Dermatology Department, St Vincent's University Hospital, Dublin, Ireland.
authors: Paul
authors: P
authors: Collins
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D016903:Drug Monitoring / Q000379:methods*; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D011565:Psoriasis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D008727:Methotrexate