Effect of Methotrexate Discontinuation on Psoriatic Patients with Significant Liver Fibrosis.

IF 2.2 4区医学 Q3 DERMATOLOGY

Clinical, Cosmetic and Investigational Dermatology Pub Date : 2025-09-12 eCollection Date: 2025-01-01 DOI:10.2147/CCID.S547056

Tanat Yongpisarn, Kunlawat Thadanipon, Ploysyne Rattanakaemakorn

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引用次数: 0

Abstract

Background: Patients with psoriasis, particularly those receiving systemic therapies such as methotrexate (MTX), are at increased risk of developing significant liver fibrosis. Although MTX remains widely used, its hepatotoxic potential remains controversial. Transient elastography (TE) allows non-invasive monitoring of liver fibrosis; however, data on fibrosis regression after MTX discontinuation are limited.

Objective: To assess the incidence of liver fibrosis regression in psoriasis patients following MTX withdrawal and to identify clinical and laboratory factors associated with this outcome.

Methods: We conducted a pilot cross-sectional study involving 15 prospectively recruited psoriasis patients with significant liver fibrosis (liver stiffness measurement [LSM] ≥7.1 kPa) who had discontinued MTX for at least 6 months. Fibrosis regression was defined as a >30% reduction in LSM from baseline. Univariate logistic regression was used to evaluate associations between clinical variables and fibrosis regression.

Results: Fibrosis regression was observed in 5 patients (33.3%) who had remained MTX-free for a mean duration of 3.6 ± 3.1 years. MTX treatment duration >4 years was significantly associated with fibrosis regression (OR = 16.00, 95% CI: 1.09-234.25; p = 0.043). A cumulative MTX dose >2 grams showed a non-significant trend toward increased odds of fibrosis regression (OR = 6.00, 95% CI: 0.56-63.98; p = 0.138). Male gender (OR = 0.17, 95% CI: 0.02-1.78; p = 0.138) showed a non-significant trend toward reduced odds of fibrosis regression.

Conclusion: One-third of psoriasis patients with significant liver fibrosis showed regression after a mean MTX-free duration of 3.6 years, with MTX use duration of more than 4 years significantly associated with this outcome. Given the small sample size, these results should be interpreted with caution. Nonetheless, these findings suggest a potential benefit of MTX withdrawal in selected patients and warrant confirmation in larger, prospective studies.

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甲氨蝶呤停药对银屑病肝纤维化患者的影响。

背景：银屑病患者，特别是接受甲氨蝶呤（MTX）等全身治疗的患者，发生显著肝纤维化的风险增加。尽管甲氨蝶呤仍被广泛使用，但其潜在的肝毒性仍存在争议。瞬时弹性成像（TE）允许无创监测肝纤维化；然而，MTX停药后纤维化消退的数据有限。目的：评估甲氨蝶呤停药后银屑病患者肝纤维化消退的发生率，并确定与此结果相关的临床和实验室因素。方法：我们进行了一项前瞻性横断研究，纳入了15名前瞻性招募的伴有明显肝纤维化（肝硬度测量[LSM]≥7.1 kPa）的银屑病患者，这些患者停用MTX至少6个月。纤维化消退定义为LSM较基线减少约30%。单变量逻辑回归用于评估临床变量与纤维化回归之间的关联。结果：5例（33.3%）患者在平均3.6±3.1年的时间内未使用甲氨喋呤，观察到纤维化消退。MTX治疗时间bbb4年与纤维化消退显著相关（OR = 16.00, 95% CI: 1.09-234.25; p = 0.043）。MTX的累积剂量为0.2 g时，纤维化消退的几率增加的趋势不显著（OR = 6.00, 95% CI: 0.56-63.98; p = 0.138）。男性（OR = 0.17, 95% CI: 0.02-1.78; p = 0.138）显示出纤维化消退几率降低的无显著趋势。结论：三分之一的显著肝纤维化银屑病患者在平均3.6年无甲氨蝶呤治疗后出现消退，使用甲氨蝶呤超过4年与此结果显著相关。鉴于样本量小，这些结果应谨慎解释。尽管如此，这些研究结果表明，在选定的患者中，停药MTX有潜在的益处，值得在更大规模的前瞻性研究中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical, Cosmetic and Investigational Dermatology Medicine-Dermatology

CiteScore

2.80

自引率

4.30%

发文量

353

审稿时长

16 weeks

期刊介绍： Clinical, Cosmetic and Investigational Dermatology is an international, peer-reviewed, open access journal that focuses on the latest clinical and experimental research in all aspects of skin disease and cosmetic interventions. Normal and pathological processes in skin development and aging, their modification and treatment, as well as basic research into histology of dermal and dermal structures that provide clinical insights and potential treatment options are key topics for the journal. Patient satisfaction, preference, quality of life, compliance, persistence and their role in developing new management options to optimize outcomes for target conditions constitute major areas of interest. The journal is characterized by the rapid reporting of clinical studies, reviews and original research in skin research and skin care. All areas of dermatology will be covered; contributions will be welcomed from all clinicians and basic science researchers globally.