Liver disease may be more common in patients on methotrexate for psoriatic disease
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Patients on methotrexate for psoriasis or psoriatic arthritis were more likely to develop liver complications than those taking it for rheumatoid arthritis, according to a study.
“Psoriasis (PsO), psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are common Th1/Th17-mediated disorders that present with a spectrum of skin and/or joint manifestations,” Joel M. Gelfand, MD, MSCE, of the department of dermatology at University of Pennsylvania Perelman School of Medicine, and colleagues wrote. “Methotrexate has been a long-standing first-line therapy for all three diseases, but hepatoxicity is a well-recognized side effect.”
Danish subjects with PsO, PsA or RA who received methotrexate between 1997 and 2015 were included in this population-based cohort study.
There were 5,687 patients with PSO, while patients with PsA and RA totaled 6,520 and 28,030, respectively.
Mild liver disease had an incidence rate per 1,000 person-years of 4.22 (95% CI, 3.61-4.91) for PsO, 2.39 (95% CI, 1.95-2.91) for PsA and 1.39 (95% CI, 1.25-1.55) for RA.
For cirrhosis-related hospitalization, the least common but most serious liver-related occurrence, the incidence rate per 1,000 person-years was 0.73 (95% CI, 0.49-1.05) for PsO, 0.32 (95% CI, 0.18-0.54) for PsA and 0.22 (95% CI, 0.17-0.29) for RA.
Compared with those with RA, those with PsO had a significantly increased risk for mild liver disease (HR = 2.22; 95% CI, 1.81-2.72), moderate to severe liver disease (HR = 1.56; 95% CI, 1.05-2.31), cirrhosis (HR = 3.38; 95% CI, 2.44-4.68) and hospitalization due to cirrhosis (HR = 2.25; 95% CI, 1.37-3.69).
In addition, patients with PsA had a greater risk for mild liver disease (HR = 1.27; 95% CI, 1.01-1.60) and cirrhosis (HR = 1.63; 95% CI, 1.10-2.42).
“These finding suggest that conservative liver monitoring is warranted in patients receiving methotrexate for psoriatic disease, particularly PsO,” the authors wrote. “Future studies are needed to determine the mechanisms driving differences in liver disease risk among PsO, PsA and RA.”