ปัจจัยเสี่ยงของการเกิดพังผืดในตับระยะรุนแรง ในผู้ป่วยโรคสะเก็ดเงินที่ได้รับ การรักษาด้วยยาเมโธเทรกเซทระยะยาว ในโรงพยาบาลสวรรค์ประชารักษ์

Rattikorn Thungsuk

Authors

Rattikorn Thungsuk Sawanpracharak Hospital

Keywords:

advanced liver fibrosis, Methotrexate, psoriasis, transient elastography

Abstract

Background: Methotrexate-associated liver fibrosis is a well-established concern. Nonetheless, several studies stated that methotrexate is not the main culprit of liver fibrosis, but other risk factors including comorbid diseases such as diabetes, hypertension, and hyperlipidemia were identified as potential contributors. Nowadays transient elastography (TE) is becoming widely used since it is non-invasive, repeatable, and affordable. This study aimed to provide the association between advanced liver fibrosis evaluated by TE and previously mentioned risk factors in psoriatic patients with long-term methotrexate therapy for more than 6 months.

Methods: A single-center cross-sectional study was conducted between January 2020 to December 2022 at Sawanpracharak Hospital, Thailand. There were 272 psoriatic patients receiving methotrexate during this period. The patient characteristics and risk factors were analyzed. Advance-stage liver fibrosis was defined by TE ≥ 7.9 kPa.

Results: A total of 272 patients were included, out of which 59 patients exhibited advanced liver fibrosis. Within this group, there was a significant of having a Body Mass Index (BMI) ≥ 30 (44.1% vs. 14.6%, p-value <0.01), hypertension (59.3% vs. 23.9%, p-value<0.01), hyperlipidemia (40.7% vs. 23.5%, p-value<0.01), diabetes mellitus (32.2% vs. 9.4%, p-value<0.01). However, factors such as the cumulative dose and duration of methotrexate use, gender, viral hepatitis infection, and alcohol consumption did not show a significant association with advanced liver fibrosis. According to multivariable analysis, BMI ≥ 30, hypertension, and diabetes mellitus were significant risk factors (Adjusted OR = 5.51, 3.32, and 3.02 respectively, p-vaulue<0.01)

Conclusion: In this study, the cumulative dose and duration of methotrexate use were not significantly associated with advanced liver fibrosis in psoriasis patients. However other risk factors such as hypertension, diabetes mellitus, and morbid obesity played a major role in causing advanced liver fibrosis in this group. Transient elastography is recommended before methotrexate therapy, especially among patients with hypertension, diabetes mellitus, and BMI ≥ 30. However, larger participant studies may required to confirm our results.

Keywords: advanced liver fibrosis, methotrexate, psoriasis, transient elastography

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