Publication: Incidence and risk factors of hepatic fibrosis in psoriatic patients receiving methotrexate with concomitant acitretin therapy and methotrexate monotherapy
Issued Date
2021-01-01
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ISSN
11778881
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2-s2.0-85107719399
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Mahidol University
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SCOPUS
Bibliographic Citation
Drug Design, Development and Therapy. Vol.15, (2021), 2299-2307
Suggested Citation
Ploysyne Rattanakaemakorn, Prinpat Pinyowiwat, Wimolsiri Iamsumang, Kumutnart Chanprapaph, Poonkiat Suchonwanit Incidence and risk factors of hepatic fibrosis in psoriatic patients receiving methotrexate with concomitant acitretin therapy and methotrexate monotherapy. Drug Design, Development and Therapy. Vol.15, (2021), 2299-2307. doi:10.2147/DDDT.S304168 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78977
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Title
Incidence and risk factors of hepatic fibrosis in psoriatic patients receiving methotrexate with concomitant acitretin therapy and methotrexate monotherapy
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Abstract
Background: The use of methotrexate-acitretin (MTX-ACI) combination therapy in treating psoriasis has been limited due to concerns related to hepatic fibrosis. However, in vitro evidence revealed a protective effect of acitretin in methotrexate (MTX)-induced liver fibrosis. Objective: This study aimed to compare the real-life incidence of hepatic fibrosis in patients with psoriasis receiving MTX-ACI and MTX monotherapy and to investigate factors associated with hepatic fibrosis in MTX-exposed patients. Methods: A retrospective cohort study was conducted based on a real-life registry containing data on patients with psoriasis who were administered MTX-ACI or MTX between 2008 and 2019 and underwent transient elastography according to cumulative MTX dose of 1.0–1.5 g and/or 3.5–4.0 g. Time-to-event analysis was performed to determine the cumulative inci-dence, incidence rate, and factors potentially affecting the occurrence of hepatic fibrosis. Results: Of the 160 patients, 32 (20%) were treated with MTX-ACI, and 128 (80%) with MTX alone. Four patients (12.5%) in MTX-ACI group and 21 (16.4%) in MTX group developed hepatic fibrosis (p = 0.59). There was no statistically significant difference in cumulative incidence (16% in MTX-ACI vs 17% in MTX, p = 0.89) and incidence rate (37 cases per 1000 person-year in MTX-ACI vs 23 cases per 1000 person-year in MTX; hazard ratio [HR] = 1.07; p = 0.90) of hepatic fibrosis between the two groups. Diabetes and obesity were identified as significant factors associated with hepatic fibrosis (adjusted HR = 2.40, 95% confidence interval [CI]: 1.05–5.51; p = 0.04 and adjusted HR = 3.28, 95% CI: 1.18–9.16; p = 0.02, respectively) regardless of the cumulative MTX dose. Conclusion: The incidence of hepatic fibrosis in a real-life clinical situation, determined by transient elastography in patients with psoriasis receiving MTX-ACI, was not increased com-pared to those receiving MTX monotherapy. Type 2 diabetes mellitus and obesity were identified as risk factors of hepatic fibrosis; hence, patients with these factors receiving long-term MTX therapy should be regularly monitored for this particular event.