Abstract
UTILIZATION OF METHOTREXATE & MONITORING OF HEPATOTOXICITY IN A PSORIASIS PATIENT

Darshan Champaneria, Dindayal Agrawal, Shyamal Prajapati, Rohit Kumar, Dr. Radhika Bindu*

ABSTRACT

Introduction: Methotrexate (MTX) induces hepatic fibrosis in psoriasis patients who take the medicine for a long period. Patients are currently monitored for MTX-induced hepatic fibrosis by performing a liver biopsy, which is risky and time-consuming for the patient, or by monitoring plasma procollagen type III amino peptide (PIIINP), which is unconvincing. The objective of this study was to find new non-invasive biomarkers that may be used to monitor psoriasis patients for MTX-induced hepatic fibrosis & serum liver fibrosis test (Hepascore & Fibrotest score) might predict the risk of adverse liver-related outcomes and mortality. Methods: A relevant article search was done using search terms like methotrexate ADR, clinical application on routine monitoring in clinical practice & Methotrexate used in psoriasis patients & Monitoring of hepatotoxicity in psoriasis patients (Drug-induced liver injury) on Google Scholar, PubMed, Medline, Cochrane library. Results: When MTX is combined with folic acid, its efficacy is reduced while its tolerance is increased. Because the incidence of hepatic fibrosis varies so widely in the literature, it is impossible to quantify the risk of hepatic fibrosis. Type 2 diabetes and obesity were found to be linked to a higher incidence of liver fibrosis. Hepatitis B and C, and alcohol usage, were linked to a slightly higher but non-significant incidence of liver fibrosis. The most widely validated approach for monitoring liver fibrosis was Procollagen III for detection of hepatic fibrosis dosage, which had a sensitivity of 77.3 percent and a specificity of 91.5 percent. Conclusions: As a conclusion, we believe that the chance of developing advanced hepatic fibrosis while taking methotrexate for psoriasis is low in low-risk people, and that methotrexate is not the cause of the increasing liver disease. Psoriatic patients are inclined to acquire NAFLD by nature, and even more so when risk factors are present, so all patients should be tested for risk factors and the presence of NAFLD before beginning treatment. Hepascore monitoring in long-term MTX users could be an effective management technique for detecting liver fibrosis progression. The link between a higher Hepascore and all-cause mortality needs to be investigated further.

Keywords: Methotrexate, Hepatotoxicity, utilization, contraindication, adverse effect in a psoriasis patient.


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