Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity

@article{Montaudi2011MethotrexateIP,
  title={Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity},
  author={Henri Montaudi{\'e} and Emilie Sbidian and Carle Paul and A Linares Maza and Adeline Gallini and S{\'e}lim Aractingi and François Aubin and Herv{\'e} Bachelez and Bernard Cribier and Pascal Joly and Denis Jullien and Michel Le Ma{\^i}tre and Laurent Misery and M-A Richard and J. P. Ortonne},
  journal={Journal of the European Academy of Dermatology and Venereology},
  year={2011},
  volume={25}
}
Background/Aim  To define practical use and to specify the ideal method for monitoring the liver toxicity of MTX in the management of psoriasis. 

Assessment of methotrexate hepatotoxicity in psoriasis patients: a prospective evaluation of four serum fibrosis markers

TLDR
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TLDR
Despite its widespread use in psoriasis therapy, dermatologists' practice regarding the use of methotrexate has not been investigated on global scale.

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TLDR
There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis and the need to select patients suitable for this type of treatment based on their prior Psoriasis history.

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TLDR
This work sought to synthesise the published literature to evaluate the association between methotrexate hepatotoxicity and cumulative dose.

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TLDR
There is limited information on systemic and biological treatment optimization and transitioning in routine clinical practice and there is a need for more research into this area.

Treatment of Extensive Plaque Psoriasis and Psoriatic Arthropathy using Methotrexate in a Patient with High Serum Alkaline Phosphatase

TLDR
A 60-year-old female with extensive skin psoriasis and psoriatic arthropathy is treated with oral methotrexate in the presence of a relative contraindication to this therapy, which shows high serum alkaline phosphatase and low serum albumen.

A randomized, double-blind, placebo-controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis

TLDR
Etanercept plus methotrexate combination therapy has not been adequately investigated in psoriasis and the safety and effectiveness of this combination therapy is still under investigation.

Methotrexate vs. fumaric acid esters in moderate‐to‐severe chronic plaque psoriasis: data registry report on the efficacy under daily life conditions

Objective  To compare the clinical efficacy of methotrexate (MTX) vs. fumaric acid esters (FAE) in psoriasis treated under daily life conditions.

Methotrexate: Underused and Ignored?

TLDR
International data on medication utilization suggest that this drug is rarely used in clinical practice for an indication of Crohn’s disease, and the potential reasons for the underuse are investigated.

TT genotype of rs10036748 in TNIP1 shows better response to methotrexate in a Chinese population: a prospective cohort study

Methotrexate (MTX) is an efficacious treatment for psoriasis; however, its widespread application is limited by its unpredictable efficacy.
...

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TLDR
No previous studies comparing methotrexate and ciclosporin for moderate to severe plaque psoriasis had been performed, so this was the first study of its kind.

Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists

TLDR
There is a high level of heterogeneity regarding the practical use of conventional systemic treatment in psoriasis and the need to select patients suitable for this type of treatment based on their prior Psoriasis history.

Efficacy and safety of mycophenolate mofetil vs. methotrexate for the treatment of chronic plaque psoriasis

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The once-weekly treatment with methotrexate for moderate to severe chronic plaque psoriasis and mycophenolate mofetil for inflammation has shown promising results in animal studies.

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TLDR
The Fibroscan® and the Fibrotest are two novel, non‐invasive methods that might be able to assess MTX‐induced hepatic fibrosis in psoriasis patients.

Methotrexate hepatotoxicity in psoriasis. Consideration of liver biopsies at regular intervals.

TLDR
Age of the patient and duration of therapy have been found to be significant factors in those patients receiving only the weekly oral dosage schedule and fibrosis of the liver developed to a degree that contraindicated further treatment with methotrexate.

The value of amino‐terminal propeptide of type III procollagen in routine screening for methotrexate‐induced liver fibrosis: a 10‐year follow‐up

TLDR
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Methotrexate hepatotoxicity in psoriatics: report of 104 patients from Nova Scotia, with analysis of risks from obesity, diabetes and alcohol consumption during long term follow-up.

TLDR
It is shown that diabetic patients are particularly at increased risk of MTX hepatotoxicity, and three patients who developed cirrhosis over two years of standard MTX therapy may represent a subset of psoriatics with increased hepatic susceptibility to MTX.