METHOTREXATE-INDUCED LIVER-CIRRHOSIS - CLINICAL, HISTOLOGICAL AND SEROLOGICAL STUDIES - A FURTHER 10-YEAR FOLLOW-UP

Background: Methotrexate (MTX) may induce liver damage, which in some psoriatics will lead to fibrosis or cirrhosis. Studies performed 10 ye ars ago on 25 patients with MTX-induced liver cirrhosis indicated that this type of cirrhosis was not of an aggressive nature. Objective: Th e aim of this study was to evaluate the present status of surviving pa tients 10 years later, together with the latest clinical and histologi cal data on patients who had died. Methods: The investigations were ca rried out on 186 liver biopsies and 5 autopsies. All biopsies were stu died by the same pathologist. Eleven surviving patients were also stud ied by analysis of serum aminoterminal propeptide of type III procolla gen (PIIINP), which is an indicator of fibrogenesis, which is especial ly suitable for follow-up of fibrotic liver disease. Results: Thirteen patients had died; 1 of these died of liver failure. Another patient died from an overdose due to misunderstanding of the prescribed dosage given elsewhere. The remaining deaths were non-MTX related, but all 5 autopsies showed some degree of cirrhosis. On the other hand, 13 pati ents had no histologically verified liver cirrhosis in their latest bi opsy, and PIIINP was within the normal range in all 11 patients invest igated, this in spite of total cumulative MTX doses from 1,120 to 18,6 45 mg (mean 7,171 mg). Conclusions: This study confirmed that in most patients MTX-induced liver cirrhosis is not aggressive. However, conti nued low-dose MTX led, in spite of normal liver tests, 8 years after t he last biopsy to liver failure and death in 1 of our patients. Our da ta support the continued use of liver biopsies in the surveillance of MTX-treated psoriatics.