Bauer B, et al. – This study gauged the utility of NASH FibroSure, a noninvasive test for nonalcoholic steatohepatitis (NASH) and hepatic fibrosis, in patients with psoriasis. The intent was to determine the eligibility for methotrexate sodium (MTX) therapy, monitor for MTX–induced hepatotoxic effects and for worsening of hepatic fibrosis scores during MTX therapy. A high prevalence of elevated hepatic steatosis scores was reported. This test monitored the variations in fibrosis score in patients with psoriasis receiving MTX. Hence, in order to assist in the monitoring of risk of worsening fibrosis during MTX therapy, this test could be used, particularly among female patients,

Methods

• The scheme of this trial was a retrospective descriptive analysis.
• It included patients with psoriasis treated with MTX who underwent NASH FibroSure testing between January 1, 2007, and December 31, 2013, at a dermatology referral center at a single institution.
• Data analysis was performed from January 1 to December 31, 2014.
• The main outcome was NASH FibroSure risk scores illustrating the development and progression of hepatic fibrosis in patients with psoriasis receiving long-term MTX therapy.

Results

• The enrollment constituted 129 patients with psoriasis undergoing treatment with MTX, while 107 patients (57 women and 50 men; mean [SD] age, 83.3 [13.5] years) underwent NASH FibroSure testing during MTX therapy and were eligible for correlation analysis.
• 69 (53.5%) patients underwent NASH FibroSure testing prior to starting MTX. 19 among them (27.5%) reported elevated fibrosis scores, and 54 (78.3%) had elevated steatosis scores.
• Among the 107 patients who underwent NASH FibroSure testing during MTX therapy, the cumulative MTX dose corresponded to a statistically marked link with a higher NASH FibroSure hepatic fibrosis score in women (Spearman ρ = 0.21; P = .02) but not in men (Spearman ρ = 0.17; P = .11).
• All patients, with the exception of 1 were managed without a liver biopsy.