Evaluation of NASH FibroSure Test in Psoriasis Patients Undergoing Methotrexate Treatment
Understanding Psoriasis and Methotrexate
Psoriasis is an autoimmune condition marked by dry, red, itchy, and scaly patches on the skin. Since the 1970s, methotrexate, initially developed for cancer treatment, has been utilized for managing severe psoriasis. However, prolonged use of this medication can lead to complications such as nonalcoholic fatty liver disease (NAFLD) and liver fibrosis, conditions that mimic alcoholic hepatitis but occur in individuals without alcohol consumption. Liver fibrosis is characterized by excessive scar tissue due to ongoing liver inflammation, potentially progressing to cirrhosis. The long-term effects of methotrexate-induced liver damage in psoriasis patients remain inadequately understood.
Research on NASH FibroSure
In a recent study, Green and colleagues explored the NASH FibroSure test as a non-invasive alternative to traditional liver biopsies. The objective was to assess whether this test could help determine the suitability of psoriasis patients for methotrexate, monitor hepatotoxic effects, and track liver fibrosis progression during treatment. The findings were published in JAMA Dermatology.
Study Overview
This retrospective analysis involved 129 psoriasis patients receiving methotrexate at a single institution. Out of these, 107 patients (57 women and 50 men) with an average age of 83 underwent NASH FibroSure testing while on treatment. A positive correlation was observed between cumulative methotrexate dosage and increased NASH FibroSure scores for liver fibrosis in women, although this correlation was not present in men. Additionally, 69 participants were tested before starting treatment, revealing elevated fibrosis scores in 19 patients and elevated steatosis scores in 54 patients. Notably, only two individuals underwent liver biopsies for treatment management.
Limitations of the Study
The authors noted several limitations in their study. The risk scores generated by NASH FibroSure are based on mathematical models rather than direct fibrosis measurements. Furthermore, the small number of liver biopsies (only two) raises concerns about validating fibrosis scores. The lack of a controlled environment for the patient cohort leaves the progression of NAFLD and changes in fibrosis scores uncertain. Moreover, as all participants identified as non-Hispanic white, the results may not be generalizable to other racial and ethnic groups. Future research should involve multi-institutional studies that include diverse populations and compare psoriasis patients on methotrexate with those receiving alternative treatments.
Conclusions and Implications
The study’s results indicated a high prevalence of elevated liver fibrosis scores among psoriasis patients tested with NASH FibroSure. These findings suggest that some patients may need to consider alternative treatments for psoriasis. While the NASH FibroSure test may not entirely replace liver biopsies, it could serve as a useful non-invasive method to monitor changes in NAFLD and liver fibrosis in psoriasis patients undergoing methotrexate treatment, particularly for women.
References
Bauer B, Chyou PH, Stratman EJ, Green C. Noninvasive Testing for Nonalcoholic Steatohepatitis and Hepatic Fibrosis in Patients With Psoriasis Receiving Long-term Methotrexate Sodium Therapy. JAMA Dermatol. 2017 Aug 23. doi:10.1001/jamadermatol.2017.2083.
Psoriasis Treatments, Systemic Medications: Methotrexate, National Psoriasis Foundation website https://www.psoriasis.org/about-psoriasis/treatments/systemics/methotrexate. Accessed September 1st, 2017.