Patients with psoriasis receiving methotrexate sodium (MTX) therapy may benefit from a noninvasive test that can effectively monitor changes in fibrosis score, according to recent research published in JAMA Dermatology

Although a liver biopsy is the standard for detecting and monitoring hepatic fibrosis in people with psoriasis receiving long-term MTX therapy, this type of biopsy is an invasive procedure with associated risks and complications. This single-institution cohort study sought to determine whether a noninvasive test for nonalcoholic steatohepatitis might serve as an alternative to liver biopsy.

Researchers evaluated 107 patients with psoriasis treated with MTX who underwent NASH FibroSure® testing at a dermatology referral center. The main outcome was NASH FibroSure risk scores suggesting development of hepatic fibrosis.

Findings showed elevated steatosis scores in 54 of 69 patients (78.3%). In women, the NASH FibroSure detected a significant link between increasing MTX dose and worsening fibrosis score.

“Our cohort demonstrated a high prevalence of baseline fatty liver changes when the NASH FibroSure test was used as a screening tool,” the investigators concluded. “The study also suggests that patients with psoriasis receiving long-term MTX therapy can be managed without a liver biopsy or gastroenterology consultation.” While a NASH FibroSure test cannot replace a liver biopsy, it can significantly reduce the number of biopsies conducted.

One limitation of the study is that the NASH FibroSure test generates a risk score for hepatic fibrosis, not an actual measure of fibrosis. The study was also limited as the entire cohort identified as non-Hispanic white, which limits the ability to generalize data.

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Reference

Bauer B, Chyou P, Stratman EJ, Green C. Noninvasive testing for nonalcoholic steatopepatitis and hepatic fibrosis in patients with psoriasis receiving long-term methotrexate sodium therapy [published online August 23, 2017]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.2083.