Background: Methotrexate (MTX) use is associated with hepatic fibrosis in psoriasis patients. To monitor this serial liver biopsies were performed. The Fibroscan® and the Fibrotest are two novel, non-invasive methods that might be able to assess MTX-induced hepatic fibrosis. Aim: Evaluating the accuracy and feasibility of the Fibroscan® and Fibrotest to detect significant MTX-induced liver fibrosis in psoriasis patients. Methods: We assessed 24 psoriasis patients who had a recent liver biopsy during MTX use. The results from the Fibroscan® and Fibrotest were compared with liver histology. Results: Fibroscan® values (n=20) ranged between 3.3 and 18.4kPa (median value 6.4kPa) and correctly identified 88% of the patients without significant liver fibrosis (Metavir score <F2, Fibroscan® ≤7.1kPa). The Fibrotest identified 83% of the patients with significant liver fibrosis (Metavir score ≥F2, Fibrotest >0.31). Conclusion: In this population, Fibrotest accurately predicted the presence of significant liver fibrosis while the Fibroscan® accurately predicted the absence of significant liver fibrosis in MTX users. This suggests that a combination of Fibrotest and Fibroscan® should prospectively be evaluated in monitoring and detecting significant MTX-induced liver fibrosis in psoriasis patients.

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Liver International
Erasmus MC: University Medical Center Rotterdam

Berends, M., Snoek, J., de Jong, E., van Krieken, H., de Knegt, R., van Oijen, M., … Drenth, J. (2007). Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: Fibrotest predicts the presence and Fibroscan® predicts the absence of significant liver fibrosis. Liver International, 27(5), 639–645. doi:10.1111/j.1478-3231.2007.01489.x