Patients with psoriatic disease, particularly those with psoriasis (PsO), appear to have an increased risk for liver disease in the setting of methotrexate therapy compared with patients with rheumatoid arthritis (RA), study findings published in the Journal of the American Academy of Dermatology suggest.

This population-based study included patients from Denmark with psoriasis (n=5687), psoriatic arthritis (n=6520), and RA (n=28,030) who were included in the National Patient Register. All patients included in the cohort study had received 1 or more prescriptions for methotrexate from 1997 to 2015. The 3 patient populations were compared with respect to the incidence of mild liver disease, moderate to severe liver disease, cirrhosis, and hospitalization related to cirrhosis. Mild liver disease was defined as chronic hepatitis or cirrhosis without portal hypertension, and moderate to severe liver disease was defined as liver failure, portal hypertension, hepatic encephalopathy, or esophageal varices.

The incidence rates per 1000 person-years for mild liver disease, the most common outcome, were 4.22 (95% CI, 3.61-4.91) for psoriasis, 2.39 (95% CI, 1.95-2.91) for psoriatic arthritis, and 1.39 (95% CI, 1.25-1.55) for RA. Incidence rates per 1000 person-years for the least common but most serious outcome, cirrhosis-related hospitalization, were 0.73 (95% CI, 0.49-1.05) for PsO, 0.32 (95% CI, 0.18-0.54) for psoriatic arthritis, and 0.22 (95% CI, 0.17-0.29) for RA.


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Compared with patients with RA, patients with psoriasis had significantly increased risks for mild liver disease (hazard ratio [HR], 2.22; 95% CI, 1.81-2.72), moderate to severe liver disease (HR, 1.56; 95% CI, 1.05-2.31), cirrhosis (HR, 3.38; 95% CI, 2.44-4.68), and cirrhosis-related hospitalization (HR, 2.25; 95% CI, 1.37-3.69). Those with psoriatic arthritis also had significantly increased risks for mild liver disease (HR, 1.27; 95% CI, 1.01-1.60) and cirrhosis (HR, 1.63; 95% CI, 1.10-2.42) compared with those with RA.

Limitations of this study included the lack of disease severity data as well as the researchers’ inability to determine the extent methotrexate use had on liver disease risk.

The investigators concluded that the findings from this study “suggest that conservative liver monitoring is warranted in patients receiving methotrexate for psoriatic disease,” particularly psoriasis.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Gelfand JM, Wan J, Zhang H, et al. Risk of liver disease in patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis receiving methotrexate: A population-based study. Published online February 16, 2021. J Am Acad Dermatol. doi:10.1016/j.jaad.2021.02.019