Eighty-eight patients with severe psoriasis, 69 of whom had been treated with methotrexate, were studied by liver biopsy. Cirrhosis occurred in five patients receiving more than 2 gm of methotrexate. Hepatic fibrosis and portal inflammation, which were also noted in the methotrexate-treated patients, appeared to be dose related, but not the fatty infiltration and focal necrosis that occurred in both treated and untreated patients. Some fibrosis was also seen in non-methotrexate-treated psoriatics.
Liver function tests were poor indicators of hepatic pathologic conditions demonstrated on liver biopsy.
Long-term methotrexate therapy is hepatotoxic in some individuals and should not be used when other modes of therapy are adequate.
Tobias H, Auerbach R. Hepatotoxicity of Long-Term Methotrexate Therapy for Psoriasis. Arch Intern Med. 1973;132(3):391–396. doi:10.1001/archinte.1973.03650090071013
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