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Original Investigation
October 2017

Noninvasive Testing for Nonalcoholic Steatohepatitis and Hepatic Fibrosis in Patients With Psoriasis Receiving Long-term Methotrexate Sodium Therapy

Author Affiliations
  • 1Pariser Dermatology Specialists, Norfolk, Virginia
  • 2Bioinformatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
  • 3Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
JAMA Dermatol. 2017;153(10):977-982. doi:10.1001/jamadermatol.2017.2083
Key Points

Question  Can a noninvasive test for nonalcoholic steatohepatitis be used as an alternative to liver biopsy and imaging for monitoring hepatic fibrosis in patients with psoriasis who are taking methotrexate sodium?

Findings  In this single-institution cohort study, 54 of 69 patients (78.3%) had elevated steatosis scores. Women displayed a significant correlation between worsening fibrosis score detected by NASH FibroSure and an increasing cumulative methotrexate dose; this correlation was not observed in men.

Meaning  The NASH FibroSure test may be used for monitoring of hepatic fibrosis scores in patients with psoriasis who are taking methotrexate; worsening fibrosis scores can indicate the need to switch to an alternative systemic agent without performing a liver biopsy.

Abstract

Importance  The long-term implications of hepatotoxic effects in patients with psoriasis remains uncharacterized, and a method is needed for the noninvasive monitoring of the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term methotrexate therapy.

Objective  To evaluate if NASH FibroSure, a noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis, can be used for patients with psoriasis to aid in determining eligibility for methotrexate sodium (MTX) therapy, monitor for the development of MTX-induced hepatotoxic effects, and monitor for worsening of hepatic fibrosis scores during MTX therapy.

Design, Setting, and Participants  A retrospective descriptive analysis was conducted among a cohort of patients with psoriasis treated with MTX who underwent NASH FibroSure testing between January 1, 2007, and December 31, 2013, at a dermatology referral center at a single institution. Data analysis was performed from January 1 to December 31, 2014.

Main Outcomes and Measures  NASH FibroSure risk scores suggesting the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term MTX therapy.

Results  Included in the institutional experience portion of the study were 129 patients with psoriasis undergoing treatment with MTX, while 107 patients (57 women and 50 men; mean [SD] age, 83.3 [13.5] years) underwent NASH FibroSure testing during MTX therapy and were eligible for correlation analysis. Of the 129 patients with psoriasis undergoing treatment with MTX, 69 (53.5%) underwent NASH FibroSure testing prior to starting MTX; 19 of those patients (27.5%) had elevated fibrosis scores, and 54 (78.3%) had elevated steatosis scores. Among the 107 patients who underwent NASH FibroSure testing during MTX therapy, the cumulative MTX dose corresponded to a statistically significant association of a higher NASH FibroSure hepatic fibrosis score in women (Spearman ρ = 0.21; P = .02) but not in men (Spearman ρ = 0.17; P = .11). All patients in the cohort except 1 were managed without a liver biopsy.

Conclusions and Relevance  The patients with psoriasis in this study had a high prevalence of elevated hepatic steatosis scores. The NASH FibroSure test can be used to monitor changes in fibrosis score in patients with psoriasis receiving MTX. In a single-institution cohort, these results suggest that NASH FibroSure may be used, especially among female patients, to help monitor for risk of worsening fibrosis during MTX therapy.

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