Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic performance of transient elastography for detection of methotrexate-induced liver injury using Roenigk classification in Asian patients with psoriasis: a retrospective study

  • Concise Communication
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Liver biopsy, the gold standard for monitoring methotrexate-induced liver fibrosis in psoriasis patients, has potential morbidity and mortality. Transient elastography (TE) has been widely used as an alternative non-invasive method. Currently, psoriasis-specific data of TE comparing to Roenigk histopathology is lacking. This retrospective study assessed the diagnostic performance of TE in the detection of methotrexate-induced liver injury and liver fibrosis in Asian psoriasis patients. Risk factors that associated with liver injury by TE and histopathology were also determined. Psoriasis patients who had received methotrexate and undergone both TE and liver biopsy (gold standard) examinations between 2005 and 2016 were enrolled. Ten of 41 patients developed methotrexate-induced liver injury (Roenigk grade ≥3a) and two of them had significant liver fibrosis (Metavir fibrosis stage ≥2). Area under the receiver operating characteristic curve (AUROC = 0.78) indicated that TE was capable of identifying patients with and without liver injury. Using a cut-off TE value of 7.1 kilopascal (kPa), this ultrasound-based elastography yielded 50% sensitivity and 83.9% specificity for detecting methotrexate-induced liver injury and had 50% sensitivity and 76.9% specificity for identifying significant liver fibrosis. A total cumulative dosage of methotrexate, age, gender, metabolic syndrome, and metabolic components were not significantly associated with TE values ≥7.1 kPa and Roenigk grade ≥3a. Thus, using clinical context, laboratory information, and a cut-off TE value of 7.1, TE is an attractable non-invasive tool for identify psoriasis patients who have a low probability of methotrexate-induced liver injury and significant liver fibrosis. Liver biopsy can be reserved for selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Abedini R, Salehi M, Lajevardi V et al (2015) Patients with psoriasis are at a higher risk of developing nonalcoholic fatty liver disease. Clin Exp Dermatol 40:722–727

    Article  CAS  PubMed  Google Scholar 

  2. Berends MA, Snoek J, de Jong EM et al (2007) Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: fibrotest predicts the presence and fibroscan predicts the absence of significant liver fibrosis. Liver Int 27:639–645

    Article  CAS  PubMed  Google Scholar 

  3. Bray AP, Barnova I, Przemioslo R et al (2012) Liver fibrosis screening for patients with psoriasis taking methotrexate: a cross-sectional study comparing transient elastography and liver biopsy. Br J Dermatol 166:1125–1127

    Article  CAS  PubMed  Google Scholar 

  4. Castera L, Forns X, Alberti A (2008) Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 48:835–847

    Article  PubMed  Google Scholar 

  5. Chalmers RJ, Kirby B, Smith A et al (2005) Replacement of routine liver biopsy by procollagen III aminopeptide for monitoring patients with psoriasis receiving long-term methotrexate: a multicenter audit and health economic analysis. Br J Dermatol 152:444–450

    Article  CAS  PubMed  Google Scholar 

  6. Charatcharoenwitthaya P, Phisalprapa P, Pausawasdi N et al (2016) Alanine aminotransferase course, serum hepatitis B virus DNA, and liver stiffness measurement for therapeutic decisions in hepatitis B e antigen-negative chronic hepatitis B. Hepatol Res 46:1347–1357

    Article  CAS  PubMed  Google Scholar 

  7. Chen J, Yin M, Talwalkar JA et al (2016) Diagnostic performance of MR elastography and vibration-controlled transient elastography in the detection of hepatic fibrosis in patients with severe to morbid obesity. Radiology 18:160685 (Epub ahead of print)

    Google Scholar 

  8. Ganzetti G, Campanati A, Offidani A (2015) Non-alcoholic fatty liver disease and psoriasis: so far, so near. World J Hepatol 7:315–326

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hoganson DD, Chen J, Ehman RL et al (2012) Magnetic resonance elastography for liver fibrosis in methotrexate treatment. Open J Rheumatol Autoimmune Dis 2:6–13

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kaffenberger BH, Kaffenberger JA, Wong H et al (2015) Magnetic resonance elastography and transient elastography as non-invasive analyses for liver fibrosis: can they obviate the need for liver biopsy in psoriasis patients treated with methotrexate? Int J Dermatol 54:752–756

    Article  CAS  PubMed  Google Scholar 

  11. Kalb RE, Strober B, Weinstein G et al (2009) Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 60:824–837

    Article  PubMed  Google Scholar 

  12. Maybury CM, Samarasekera E, Douiri A et al (2014) Diagnostic accuracy of noninvasive markers of liver fibrosis in patients with psoriasis taking methotrexate: a systematic review and meta-analysis. Br J Dermatol 170:1237–1247

    Article  CAS  PubMed  Google Scholar 

  13. Mohamadnelad M, Tavanger SM, Sotoudeh M et al (2010) Histopathological study of chronic hepatitis B: a comparative study of Ishak and Metavir scoring systems. Int J Organ Transplant Med 1:171–176

    Google Scholar 

  14. Montaudié H, Sbidian E, Paul C et al (2011) Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol 25:12–18

    Article  PubMed  Google Scholar 

  15. Park SH, Goo JM, Jo CH (2004) Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 5:11–18

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pongpit J, Porntharukchareon S, Kaewduang P et al (2016) Liver stiffness measurement in psoriasis: do metabolic or disease factors play the important role? Biomed Res Int 2016:7963972

    Article  PubMed  PubMed Central  Google Scholar 

  17. Roenigk HH Jr, Auerbach R, Maibach H et al (1998) Methotrexate in psoriasis: consensus conference. J Am Acad Dermatol 38:478–485

    Article  PubMed  Google Scholar 

  18. Rosenberg P, Urwitz H, Johannesson A et al (2007) Psoriasis patients with diabetics type 2 are at high risk of developing liver fibrosis during methotrexate treatment. J Hepatol 46:1111–1118

    Article  CAS  PubMed  Google Scholar 

  19. Vandenbroucke JP, Elm EV, Altman DG et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835

    Article  PubMed  Google Scholar 

  20. Yeo CM, Chong VH, Earnest A et al (2013) Prevalence and risk factors of methotrexate hepatoxicity in Asian patients with psoriasis. World J Hepatol 5:275–280

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yin M, Talwalkar JA, Glaser KJ et al (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207–1213

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge Dr. Saowalak Hunnangkul for assistance with statistical analysis and Mrs. Kingkaew Wamaphutta for assistance with data collection.

Author information

Authors and Affiliations

  1. Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, 10700, Thailand

    Pasinee Rongngern, Leena Chularojanamontri, Chanisada Wongpraparut & Narumol Silpa-Archa

  2. Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, Thailand

    Watcharasak Chotiyaputta & Phunchai Charatcharoenwitthaya

  3. Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, Thailand

    Ananya Pongpaibul

Authors
  1. Pasinee Rongngern
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leena Chularojanamontri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chanisada Wongpraparut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Narumol Silpa-Archa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Watcharasak Chotiyaputta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ananya Pongpaibul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Phunchai Charatcharoenwitthaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leena Chularojanamontri.

Ethics declarations

Funding disclosure

This was an unfunded study.

Conflict of interest

All authors have neither conflict of interest nor financial supports from pharmaceutical companies. The authors of this study hereby declare no personal or professional conflicts of interest regarding any aspect of this study.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rongngern, P., Chularojanamontri, L., Wongpraparut, C. et al. Diagnostic performance of transient elastography for detection of methotrexate-induced liver injury using Roenigk classification in Asian patients with psoriasis: a retrospective study. Arch Dermatol Res 309, 403–408 (2017). https://doi.org/10.1007/s00403-017-1733-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-017-1733-4

Keywords

Search

Navigation