Abstract Number: 62

Fibroscan monitoring for liver complications of Methotrexate use in dermatology patients

A. Chandran , M. Rademaker , R. Vyas , A. Yung , J. Irwin , E. Johns , R. Jurawan , F. Weilert

Meeting: 2014 Dermcoll

Session Information

Date: -

Session Title: Registrars’ Forum

Session Time: -

Introduction: Fibroscan is a non-invasive and validated
technique used to assess liver fibrosis. We assessed its value
in patients taking longterm methotrexate for a variety of
dermatologic indications.
Method: Baseline BMI, waist circumference, serial P3NP,
LFT’s, current and cummulative methotrexate doses were
recorded. Fibroscan measurement or transient elastography
(TE), was graded as normal (F0/F1 TE = 0–7), mild
fibrosis (F1/F2 TE = 7.1–9), moderate fibrosis F2/F3
TE = 9.1–12), or severe fibrosis/cirrhosis (F4 TE > 12).
Results: A total of 133 patients on methotrexate had
fibroscans performed; 33 were excluded due to in adequate
imaging (mostly due to obesity); 56% were females; mean
age 54 years. Indications for methotrexate were: psoriasis
(63), eczema (24), nodular prurigo (5), lichen planus (4),
and 1 each of CDLE, localised scleroderma, chronic actinic
dermatitis, Behçet’s syndrome. The mean weekly dose of
methotrexate was 14.1 mg; mean cumulative dose 1.95 gm;
mean duration of therapy 28.6 months. Eighty percent of
patients had normal fibroscans (F0/F1); 13% had mild fibrosis
(F1/F2), 3% moderate fibrosis (F2/F3) and 2% had
severe fibrosis/cirrhosis (F4). Fifteen of the 80 (18%)
patients who were F0/F1, 5/13 (38%) of the F1/F2 patients
and 100% of F2/F3/F4 patients had abnormal P3NP levels.
One patient with severe fibrosis (F4, TE 14.3) went on to
have liver biopsy that showed features of fibrosis likely due
to methotreaxte.
Conclusion: Although the number of abnormal fibroscans
was low, fibroscan with P3NP appears to be a useful risk
stratification tool for liver damage in dermatology patients
on long term methotrexate.