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 These inflammatory disorders are often treated with methotrexate, a
medication linked to an increased risk of liver disease. For the
current study, researchers followed more than 1 million people for
an average of six years to see how having conditions like psoriasis
or rheumatoid arthritis - and taking methotrexate - influenced the
odds of developing serious liver disorders.
Compared to people without chronic inflammatory diseases, people
with psoriasis were 37 percent more likely to develop liver
disorders. When psoriasis patients took methotrexate, they had
roughly twice the odds of liver damage.
With psoriatic arthritis, the increased risk of liver disease was 38
percent without drug therapy and 67 percent with methotrexate. For
rheumatoid arthritis, there was no increased risk of liver disease
when people took methotrexate, but when they didn’t they had 49
percent higher odds of liver damage.
“This study is the first, to our knowledge, to empirically support
the long held belief that psoriasis patients are more prone to
serious liver problems compared to patients without psoriasis and
those with diseases such as rheumatoid arthritis which are treated
with similar medications,” said senior study author Dr. Joel Gelfand
of the University of Pennsylvania Perelman School of Medicine in
Philadelphia.
“Medications which are toxic to the liver, such as methotrexate,
should be used cautiously in patients with psoriatic disease,
especially those with additional risk factors such as obesity or
regular alcohol use,” Gelfand said by email.
The study suggests systemic inflammation - which is present in all
three diseases - may play a significant role in development of liver
disease, particularly in those with psoriasis, researchers note in
the Journal of Investigative Dermatology.
For the study, researchers examined data on almost 1.3 million
people without chronic inflammatory disorders as well as roughly
198,000 psoriasis patients, 12,000 people with psoriatic arthritis
and 54,000 with rheumatoid arthritis.
Among people with inflammatory disorders who took systemic therapy -
medications that reach the whole body - methotrexate was the most
commonly prescribed option.
Overall, 6 percent of psoriasis patients were prescribed systemic
therapy, as were 53 percent of people with psoriatic arthritis and
61 percent of people with rheumatoid arthritis.
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Independent of risk factors commonly seen in liver disease, such as
alcohol use and diabetes, the study found that patients with
psoriatic skin or joint disease, particularly patients with more
severe skin psoriasis, had an elevated risk for serious liver
disease.
Pfizer, which sells a version of methotrexate, has hired Gelfand and
another study author as consultants and given them research grants,
although the drugmaker wasn’t involved in the design or analysis of
the current study. The authors have other financial ties to several
other drug companies.
One limitation of the study is that researchers didn’t look at
deaths from liver disease. Another drawback is that they lacked data
on whether people at risk for liver disease might have been steered
away from methotrexate to other therapies.
Even so, the findings add to evidence that patients need to consider
the liver risks associated with these disorders, said Dr. Lawrence
Eichenfield, a researcher at the University of California, San
Diego, who wasn’t involved in the study.
“Patients should be aware that psoriasis has health impacts beyond
the skin alone, and its management should be considered as an
important part of the health of an individual,” Eichenfield said by
email. “Liver function tests should be tested in psoriasis patients
and the results may influence choices for therapy.”
An alternative treatment for joint pain, non-steroidal
anti-inflammatory drugs (NSAIDS), also carry a risk of liver
disease, cautioned Dr. Alexander Egeberg, a researcher at the
University of Copenhagen who wasn’t involved in the study.
“Consequently, physicians should carefully weigh the risks and
benefits of NSAIDs as well as methotrexate when treating patients
with inflammatory diseases,” Egeberg said by email.
SOURCE: http://bit.ly/2zyiP6L Journal of Investigative Dermatology,
online November 2, 2017.
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