SEQUENTIAL LIVER BIOPSIES DURING LONG-TERM METHOTREXATE TREATMENT FORPSORIASIS - A REAPPRAISAL

One hundred and eighty-two liver biopsies were performed over a 10-yea r period on patients receiving long-term, low-dose, once weekly oral m ethotrexate (MTX) for severe psoriasis. Forty-nine patients had two or more biopsies during continued treatment and formed the study populat ion for our analysis. The first and last biopsies were compared to det ermine progression of any histological abnormalities. Liver biopsies w ere assessed without knowledge Of the MTX dose and allocated to one of five groups according to the severity of the histological abnormaliti es. These were defined as: (1) normal; (2) steatosis alone; (3) inflam mation without fibrosis; (4) fibrosis; and (5) cirrhosis. The mean cum ulative dose of MTX at the time of the first biopsy was 2743 mg (range 315-10,024), given over 275 weeks (range 26-738). In the interval bet ween the first and last biopsies, patients received, on average, a fur ther 2362 mg (range 390-7155) over 225 weeks (range 60-460). There was improvement in the histological assessment in 12 patients, no change in 28 patients, and deterioration in nine patients. None developed cir rhosis. Liver biopsy findings prompted discontinuation of MTX in four of the 49 patients on long-term treatment. This has to be weighed agai nst the cost and morbidity of the 124 biopsies performed in these pati ents. Our results suggest that, with careful follow-up, the risk of de velopment or progression of liver disease in patients receiving long-t erm, low-dose, once weekly oral MTX for psoriasis is modest, and that the requirement for performing routine liver biopsies in these patient s needs to be reconsidered.