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

Background: Methotrexate (MTX) use is associated with hepatic fibrosis in psoriasis patients. To monitor this serial liver biopsies were performed. The Fibroscan((R)) and the Fibrotest are two novel, non-invasive methods that might be able to assess MTX-induced hepatic fibrosis. Aim: Evaluating the accuracy and feasibility of the Fibroscan((R)) and Fibrotest to detect significant MTX-induced liver fibrosis in psoriasis patients. Methods: We assessed 24 psoriasis patients who had a recent liver biopsy during MTX use. The results from the Fibroscan((R)) and Fibrotest were compared with liver histology. Results: Fibroscan((R)) values (n=20) ranged between 3.3 and 18.4 kPa (median value 6.4 kPa) and correctly identified 88% of the patients without significant liver fibrosis (Metavir score < F2, Fibroscan((R)) <= 7.1 kPa). The Fibrotest identified 83% of the patients with significant liver fibrosis (Metavir score >= F2, Fibrotest > 0.31). Conclusions: In this population, Fibrotest accurately predicted the presence of significant liver fibrosis while the Fibroscan((R)) accurately predicted the absence of significant liver fibrosis in MTX users. This suggests that a combination of Fibrotest and Fibroscan((R)) should prospectively be evaluated in monitoring and detecting significant MTX-induced liver fibrosis in psoriasis patients.