Document Detail

Hepatotoxicity rates do not differ in patients with rheumatoid arthritis and psoriasis treated with methotrexate.
MedLine Citation:
PMID:  19578136     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: MTX hepatotoxicity is considered to occur more frequently in patients with psoriasis than in patients with RA. However, toxicity guidelines are based on reports from studies with small sample sizes and limited follow-up periods. The current study's objective was to examine the long-term risk of MTX hepatotoxicity based on a database review of patients with RA or psoriasis, and to examine whether the two populations differed. METHODS: We conducted a retrospective cohort review among members of a large health maintenance organization (HMO) in Israel who were diagnosed with either RA (n = 119) or psoriasis (n = 690) and who had purchased at least one dose of MTX. Liver function analyses were performed serially in these patients during the follow-up. All abnormal assays were recorded in the computerized database of the HMO. RESULTS: Both groups had hepatic enzyme elevation; the pre-disposing factors predictive of liver damage were female gender and a higher cumulative dose of MTX (hazard ratios, 1.46 and 1.07, respectively, P < 0.001). Age, concurrent diseases and type of disease had no influence on susceptibility to liver damage. No statistically significant difference was detected in any abnormal liver function test among patients with either RA or psoriasis. CONCLUSION: Our study did not corroborate previous findings of significant differences between psoriasis patients and RA patients concerning susceptibility to hepatotoxicity from MTX therapy. The only significant factor predicting a higher risk of hepatic damage was female gender.
Howard Amital; Yoav Arnson; Gabriel Chodick; Varda Shalev
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Publication Detail:
Type:  Journal Article     Date:  2009-07-03
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  48     ISSN:  1462-0332     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-18     Completed Date:  2009-10-09     Revised Date:  2009-12-09    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  1107-10     Citation Subset:  AIM; IM    
Department of Medicine D, Meir Medical Center, Kefar Saba, Israel.
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MeSH Terms
Antirheumatic Agents / administration & dosage,  adverse effects*,  therapeutic use
Arthritis, Psoriatic / drug therapy*
Arthritis, Rheumatoid / drug therapy*
Drug Administration Schedule
Drug-Induced Liver Injury*
Immunosuppressive Agents / administration & dosage,  adverse effects,  therapeutic use
Methotrexate / administration & dosage,  adverse effects*,  therapeutic use
Middle Aged
Retrospective Studies
Risk Factors
Sex Factors
Reg. No./Substance:
0/Antirheumatic Agents; 0/Immunosuppressive Agents; 59-05-2/Methotrexate
Comment In:
Rheumatology (Oxford). 2010 Jan;49(1):196-7; author reply 197-8   [PMID:  19858119 ]

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