Friday, 22 Jun 2018

You are here

MTX Doubles Hepatotoxicity Risk in Psoriasis Patients

A study from the University of Pennsylvania Perelman School of Medicine was published in the Journal of Investigative Dermatology showing that the risk of incident liver disease doubled when patients with psoriasis (PsO) or psoriatic arthritis (PsA) take methotrexate (MTX), but not when MTX is used in rheumatoid arthritis. (Citation source https://buff.ly/2i9qizC)

This was a comparative cohort study of patients with psoriasis (N=197,130), PsA (N=12,308), RA (N=54,251), and matched controls (N=1,279,754). Researchers calculated the adjusted hazard ratios for any liver disease in these patients with or without systemic therapy (ST).  Liver disease was defined as any liver disease, non-alcoholic fatty liver disease (NAFLD), and cirrhosis (any etiology).

 Overall, 6% of psoriasis patients were prescribed systemic therapy, as were 53% of people with psoriatic arthritis and 61% of people with rheumatoid arthritis. MTX was the most commonly prescribed ST. 

The Liver Disease Hazard ratios were: 

Diseasewith MTX RxHazard Ratio
PsONo1.37
PsOYes1.97
PsANo1.38
PsAYes1.49
RANo 1.49
RA Yes0.96

 

Incident NAFLD was highest in patients with PsO prescribed a ST (2.23) and PsA with ST (2.11). Risk of cirrhosis was highest among patients with PsO with an ST (2.62) and PsA without a ST (3.15).

Increasing body surface area in PsO further increased the prevalence of liver disease and cirrhosis (p for trend <0.001).

More so than RA, PsO and PsA are associated with liver disease, particularly NAFLD and cirrhosis, and this was true even among patients without systemic therapy exposure.

Compared to people without chronic inflammatory diseases, people with psoriasis were 37% more likely to develop liver disorders. When psoriasis patients took methotrexate, they had roughly twice  (67%) the odds of liver damage.  For rheumatoid arthritis, there was no increased risk of liver disease when people took methotrexate, but when they didn’t they had 49% higher odds of liver damage.

There was no data on deaths from liver disease in this study

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Increase HR in patients with no ST (eg in RA or in cirrhosis in PsA) could be confounded as clinicians may actively avoid MTX in patients with existing liver disease or cirrhosis.

More Like This

Cosentyx Gets Radiographic Protection Indication for Psoriatic Arthritis

Novartis announced today that the US Food and Drug Administration (FDA) approved the inclusion of new evidence that Cosentyx® (secukinumab) significantly slows the progression of joint structural damage at Week 24 versus placebo in those with active psoriatic arthritis (PsA).

Increased Risk of Infection in Psoriasis and Psoriatic Arthritis

As we gather more knowledge about psoriatic arthritis ( PsA) and psoriasis (PSO) over time, and achieve better outcomes with new therapies, more questions arise about quality of life, survival  and comorbidities in PsA and PSO. Similarly to RA, we learned about increased risk of CVD and malignancy. With more data compiled in cohorts it is possible now to ask the same questions as we asked in RA.

Cardiovascular Risk Factors in Psoriasis, PsA and Seronegative SpA

Not a surprise to anyone anymore, increased risk of cardiovascular disease poses a danger of significant morbidity and mortality in patients underlying inflammatory arthritides. A single center cross -sectional observational study was designed to conduct deeper analysis of Cardiovascular Risk Factors (CVRF) in patients with PsA, PSO without arthritis and SpA without PSO (THU 0297).

MRI Imaging for Sacroiliitis Requires Bone Marrow Edema for Reliability

de Winter and colleagues from the Netherlands have reported on magnetic resonance imaging of the sacroiliac joints of healthy subjects, patients with axial spondyloarthritis, runners and those with chronic back pain, and found a high incidence of sacroiliitis in many, but that deep bone marrow edema was most specific for those with axial SpA.

Cancer Risk Raised in Psoriatic Arthritis

Patients with psoriatic arthritis (PsA) were at increased risks for malignancy, and possibly more so if they were treated with conventional disease-modifying antirheumatic drugs (DMARDs), a meta-analysis found.

In nine cohort studies that included more than 43,000 PsA patients, the pooled relative risk for overall malignancy was 1.29 (95% CI 1.04-1.60) compared with the general population, according to Yunyun Fei, MD, and colleagues from Peking Union Medical College in Beijing.