01/01/2023
Methotrexate use and Risk ofHepatotoxiciy:::
Methotrexate is a key component in the treatment of inflammatory rheumatic diseases and the mainstay of therapy in rheumatoid arthritis.
In light of current evidence, it seems unlikely that methotrexate alone is capable of inducing chronic liver disease; the risk of methotrexate-induced liver injury is primarily acute in nature.
The cumulative dose of methotrexate has no predictive value for the occurrence of fibrosis.
In non-alcoholic fatty liver disease, several pathophysiological arguments suggest (in the absence of proof from clinical trials) that long-term methotrexate therapy worsens liver damage and the progression of liver disease.
Pretreatment screening is advisable to check for the possible presence of liver disease in patients being considered for methotrexate treatment.
Monthly monitoring is advocated at the beginning of methotrexate treatment, followed by 3-monthly monitoring comprising complete blood counts, liver function tests and calculation of the Fib-4 fibrosis score.
Thanks to Dr dilaram gastroenterologist and hepatologest