Avaliação da fibrose hepática em pacientes portadores de psoríase em uso de metotrexato por meio da elastografia hepática transitória

Abstract

Methotrexate (MTX) is widely used in the treatment of moderate to severe psoriasis and psoriatic arthritis. One of its most worrying adverse effects is the hepatotoxicity, due to the possibility of inducing liver cirrhosis. There are some options to monitoring this drug, however liver biopsy (LB) remains the gold standard for detection of liver fibrosis. Some consensus is routinely indicate when na accumulated dose (AD) of 3.5 to 4g is reached. Needle-assisted BH is an invasive method and has technical limitations. Therefore, transient elastography (TE) is being increasingly used to estimate non-invasively the level of liver fibrosis, with reliable results. This paper aims to evaluate the presence of liver fibrosis in patients with psoriasis using TE and its relationship with AD of MTX; correlate the body mass index (BMI) according to the TE result; and evaluate liver biochemistry according to the TE result. For that, patients with psoriasis were selected, over 18 years old, of both sexes, using MTX, phototherapy or topical treatment and who were not using acitretin, cyclosporine or immunobiologicals. All were referred to undergo TE at a single moment during the study. TE was performed using Fibroscan®, with a result greater than or equal to 7.9 compatible with advanced fibrosis and greater than or equal to 11.5 compatible with cirrhosis. The controlled attenuation parameter (CAP), FIB-4 and laboratory tests were also evaluated. The final sample consisted of 108 patients: 38 using MTX with AD between zero and 3.5 g; 31 using MTX with AD greater than 3.5 g; and 39 who were not undergoing systemic treatment, as a control group. There was no significant correlation (p=0.612) between AD of MTX and the level of liver fibrosis. When the multivariate analysis of the TE value was carried out with the risk factors, the only one with statistical significance was the BMI (coefficient: 0.217; p=0.026) and, in the logistic regression for the outcome of level of liver fibrosis, there was statistical significance, with BMI being a significant factor in the effect of the level of liver fibrosis (OR=1.18 with p=0.006). When evaluating the liver biochemistry model of logistic regression for the outcome of level of liver fibrosis, no statistical significance was observed. Therefore, the presence of obesity must be taken into consideration as a risk factor for liver fibrosis, which is probably more important than AD of MTX.