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.
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.