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lüll Monitoring methotrexate-induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?Aithal GP; Haugk B; Das S; Card T; Burt AD; Record COAliment Pharmacol Ther 2004[Feb]; 19 (4): 391-9BACKGROUND: Reports that up to 26% of subjects with psoriasis develop cirrhosis have led to a recommendation of serial liver biopsies after each cumulative dose of 1500 mg of methotrexate. AIM: To evaluate the progression of liver injury in patients with psoriasis and the impact of monitoring by liver biopsy on their management. METHODS: One hundred and twenty-one liver biopsies from 66 subjects (aged 11-79 years) with psoriasis, receiving a median cumulative dose of 3206 mg of methotrexate over a period of 280.5 weeks, were evaluated. RESULTS: The assessment of advanced fibrosis according to the Ishak system (>or= 4) correlated perfectly with that of the Scheuer system (>or= 3) and poorly with that of the Roenigk scale (>or= 3b) (r2 = 1.0 and 0.31, respectively). Two of 24 pre-treatment biopsies showed advanced fibrosis and both subjects were heavy drinkers. The cumulative probabilities of advanced fibrosis (Ishak >or= 4) were 0%, 2.6%, 2.6%, 8.2% and 8.2% at cumulative doses of 1500, 3000, 4500, 5000 and 6000 mg, respectively. None of the subjects developed cirrhosis during follow-up or discontinued therapy on the basis of liver biopsy findings. CONCLUSIONS: Advanced hepatic fibrosis with low-dose methotrexate therapy is much less frequent than previously reported. Pre-treatment or monitoring liver biopsies in accordance with the current guidelines have little impact on patient management.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Biopsy/methods[MESH]|Child[MESH]|Dermatologic Agents/*adverse effects[MESH]|Female[MESH]|Humans[MESH]|Liver Cirrhosis/*chemically induced/pathology/prevention & control[MESH]|Liver Function Tests[MESH]|Liver/*pathology[MESH]|Male[MESH]|Methotrexate/*adverse effects[MESH]|Middle Aged[MESH]|Psoriasis/*drug therapy[MESH]|Risk Factors[MESH]|Treatment Outcome[MESH] |