Psoriatic patients with chronic viral hepatitis do not have an increased risk of liver cirrhosis despite long-term methotrexate use: Real-world data from a nationwide cohort study in Taiwan

J Am Acad Dermatol. 2018 Oct;79(4):652-658. doi: 10.1016/j.jaad.2018.05.004. Epub 2018 May 10.

Abstract

Background: Methotrexate (MTX) is commonly used in the treatment of patients with moderate-to-severe psoriasis.

Objective: We conducted a nationwide population-based cohort study to investigate the impact of long-term MTX use on the risk of chronic viral hepatitis-related cirrhosis among psoriatic patients in Taiwan.

Methods: This study obtained data from the National Health Insurance Research Database in Taiwan. We identified 2417 psoriatic patients with chronic hepatitis B (CHB) (370 MTX users and 2047 nonusers of MTX) and 1127 psoriatic patients with chronic hepatitis C (CHC) (174 MTX users and 953 nonusers of MTX) from January 1, 2000, to December 31, 2010.

Results: After a mean follow-up of more than 9 years since the diagnosis of chronic viral hepatitis, a total of 125 patients with CHB (5%) and 120 patients with CHC (11%) developed liver cirrhosis. Comparable proportions of MTX users and nonusers of MTX developed liver cirrhosis (4% vs 5% in patients with CHB and 11% vs 11% in patients with CHC [both P >.05]).

Limitations: There is possible selection bias and medication nonadherence.

Conclusion: Our real-world data show that long-term MTX use may not be associated with an increased risk of liver cirrhosis among psoriatic patients with chronic viral hepatitis.

Keywords: chronic hepatitis B; chronic hepatitis C; cirrhosis; hepatotoxicity; liver; methotrexate; psoriasis; viral hepatitis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Chemical and Drug Induced Liver Injury
  • Cohort Studies
  • Databases, Factual
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Hepatitis B, Chronic / epidemiology*
  • Hepatitis B, Chronic / etiology
  • Hepatitis C, Chronic / epidemiology*
  • Hepatitis C, Chronic / etiology
  • Humans
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / etiology
  • Long-Term Care
  • Male
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use
  • Middle Aged
  • Multivariate Analysis
  • Population Surveillance
  • Prevalence
  • Prognosis
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Taiwan / epidemiology

Substances

  • Methotrexate