A pragmatic non-invasive assessment of liver fibrosis in patients with psoriasis, rheumatoid arthritis or Crohn's disease receiving methotrexate therapy.

Abstract

BACKGROUND AND AIMS:

The reported hepatotoxicity of methotrexate underlines the need for a repeated non-invasive and reliable evaluation of liver fibrosis. We estimated, using a non-invasive strategy, the prevalence of significant liver fibrosis in patients treated by methotrexate and the predictors of significant fibrosis (fibrosis≥F2).

METHODS:

Fibrosis was prospectively evaluated using 9 non-invasive tests in consecutive patients with psoriasis, rheumatoid arthritis, or Crohn's disease. Significant fibrosis was assessed without liver biopsy by defining a "specific method" (result given by the majority of the tests) and a "sensitive method" (at least one test indicating a stage≥F2).

RESULTS:

One hundred and thirty-one patients (66 Psoriasis, 40 rheumatoid arthritis, and 25 Crohn's disease) were enrolled, including 83 receiving methotrexate. Seven tests were performed on average per patient, with a complete concordance in 75% of cases. Fibroscan® was interpretable in only 61% of patients. The best performances (AUROC>0.9) for predicting significant fibrosis were obtained by tests dedicated to steatohepatitis (FibroMeter NAFLD, NFS and FPI). The prevalence of fibrosis≥F2 according to the "specific" or the "sensitive" assessment of fibrosis was 10% and 28%, respectively. Methotrexate exposure did not influence the fibrosis stage. Factors independently associated with significant fibrosis according our "sensitive method" were age, male gender, and metabolic syndrome.

CONCLUSION:

We provided a non-invasive approach for identifying liver fibrosis≥F2 by using 8 biochemical tests and Fibroscan®. In this population, the risk of significant fibrosis was related to age, male gender, and presence of metabolic syndrome, but was not influenced by methotrexate.

• Authors: Jean-Paul Cervoni, Blandine Alby-Lepresle, Delphine Weil, Peng Zhong, François Aubin, Daniel Wendling, Eric Toussirot, Lucine Vuitton, Franck Carbonnel, Raphaële Blondet, Thierry Thévenot, Paul Calès, Elisabeth Monnet, Vincent Di Martino
• Journal: Clinics and research in hepatology and gastroenterology (Clin Res Hepatol Gastroenterol) 2020 Jan-Jun Vol. 44S Pg. 100003 ISSN: 2210-741X [Electronic] France
• PMID: 33602481 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2020 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Methotrexate

Topics

• Age Factors
• Arthritis, Rheumatoid (drug therapy)
• Crohn Disease (drug therapy)
• Elasticity Imaging Techniques
• Female
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Liver Cirrhosis (chemically induced, diagnosis, epidemiology)
• Male
• Methotrexate (adverse effects, therapeutic use)
• Middle Aged
• Prevalence
• Prospective Studies
• Psoriasis (drug therapy)
• Sex Factors