No Increased Risk for Liver Cirrhosis With Long-Term Methotrexate Use for Psoriasis

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The proportion of patients in whom liver cirrhosis developed was comparable among MTX users and nonusers.
The proportion of patients in whom liver cirrhosis developed was comparable among MTX users and nonusers.

Long-term methotrexate (MTX) use among patients with psoriasis who have chronic viral hepatitis is not associated with an increased risk for liver cirrhosis, according to real-world data derived from the results of a nationwide, population-based cohort study conducted in Taiwan and published in the Journal of the American Academy of Dermatology.

The investigators sought to explore the effect of long-term MTX treatment on the risk for chronic viral hepatitis-related cirrhosis among a cohort of patients with psoriasis. Data were obtained from the National Health Insurance Research Database in Taiwan. A total of 2417 patients with psoriasis and chronic hepatitis B (CHB), 370 of whom were MTX users and 2047 of whom were nonusers, were identified.

Moreover, a total of 1127 patients with psoriasis and chronic hepatitis C (CHC), 174 of whom were MTX users and 953 of whom were nonusers, were identified as well. All data were obtained between January 1, 2000, and December 31, 2010.

After a mean follow-up of >9 years since being diagnosed with chronic viral hepatitis, liver cirrhosis developed in 5% (125 of 2417) of patients with CHB and 11% (120 of 1127) of those with CHC. The proportion of patients in whom liver cirrhosis developed was comparable among MTX users and nonusers (4% vs 5%, respectively, in patients with CHB and 11% vs 11%, respectively, in those with CHC; P <.05 for both).

Multivariate analysis with Cox proportional hazards model identified certain risk factors for liver cirrhosis among patients with psoriasis and chronic viral hepatitis.

Older age at diagnosis of viral hepatitis was considered a risk factor for liver cirrhosis among those with CHB (hazard ratio [HR] 1.04; 95% CI, 1.03-1.05) and those with CHC (HR 1.03; 95% CI, 1.02-1.05). The prescribing of hepatitis B medication was associated with a higher risk for liver cirrhosis among patients with CHB (HR 8.16; 95% CI, 5.69-11.7). A longer interval between psoriasis diagnosis and development of chronic viral hepatitis was linked with a lower risk for liver cirrhosis.

Limitations of the current study include possible selection bias and medication nonadherence.

The investigators concluded that real-world data have demonstrated no rise in the development of incident liver cirrhosis among patients with psoriasis and either CHB or CHC who have received long-term MTX therapy.

Reference

Tang KT, Chen YM, Chang SN, Lin CH, Chen DY. Psoriatic patients with chronic viral hepatitis do not have an increased risk of liver cirrhosis despite long-term methotrexate use: real-world data from a nationwide cohort study in Taiwan [published online May 9, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.004

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