Hepatic effects of long-term methotrexate use in the treatment of inflammatory bowel disease

OBJECTIVE: Methotrexate is currently used as a treatment for refractory inf lammatory bowel disease. This study sought to evaluate the hepatic effects of long-term methotrexate ther apy in patients with inflammatory bowel dise ase and to determine whether the established guidelines for monitoring meth otrexate-related hepatotoxicity with surveillance liver biopsy in patients with psoriasis or rheumatoid arthritis are applicable to these patients. METHODS: Thirty-two patients with inflammatory bowel disease receiving cumu lative methotrexate doses of greater than or equal to 1500 mg were studied. Liver chemistry tests were obtained before and during therapy. Twenty pati ents underwent liver biopsies as recommended for methotrexate-treated patie nts with psoriasis; the biopsies were reviewed and graded according to Roen igk's criteria for methotrexate-induced hepatotoxicity (a grading system fo r methotrexate hepatotoxicity in psoriasis patients) by a liver pathologist blinded to the methotrexate dose. RESULTS: In patients who had liver biopsies, the mean cumulative methotrexa te dose was 2633 mg (range, 1500-5410 mg), given for a mean of 131.7 wk (ra nge, 66-281 wk). Nineteen of 20 patients (95%) had mild histological abnorm alities (Roenigk's grade I and LT), and one patient had hepatic fibrosis (R oenigk's grade IIIB). Abnormal liver Chemistry tests, present in 6 of 20 (3 0%) patients, did not identify the patient with Roenigk's grade IIIB hepato toxicity. CONCLUSIONS: Cumulative methotrexate doses up to 5410 mg given up to 281 wk in patients with inflammatory bowel disease are associated with Little hep atotoxicity. Surveillance Liver biopsies based on cumulative methotrexate d oses an not warranted in these patients. (C) 2000 by Am. Cell. of Gastroent erology).