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Taylor DR, Stone C. Current issues with procollagen III N-terminal peptide assay performance relevant to 2016 British Association for Dermatologist methotrexate-monitoring guidance. Clin Exp Dermatol 2023; 48:1378-1379. [PMID: 37616532 DOI: 10.1093/ced/llad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
Procollagen III N-terminal peptide (P3NP) testing is routinely used to detect possible liver fibrosis according to the cutoffs in the British Association of Dermatologists (BAD) 2016 guidelines for the safe and effective prescribing of methotrexate in skin disease. We report significant changes to P3NP test performance that will potentially change patient management according to the BAD 2016 guidelines.
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Affiliation(s)
- David R Taylor
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Colin Stone
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
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2
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Patel N. Response to "Monitoring for methotrexate induced liver fibrosis in many UK dermatology centres is out of date and needs reform". Clin Exp Dermatol 2022; 47:1724-1725. [PMID: 35524752 DOI: 10.1111/ced.15253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Neil Patel
- Department of Dermatology, Imperial College Healthcare NHS Trust
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3
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Cervoni JP, Alby-Lepresle B, Weil D, Zhong P, Aubin F, Wendling D, Toussirot E, Vuitton L, Carbonnel F, Blondet R, Thévenot T, Calès P, Monnet E, Di Martino V. A pragmatic non-invasive assessment of liver fibrosis in patients with psoriasis, rheumatoid arthritis or Crohn's disease receiving methotrexate therapy. Clin Res Hepatol Gastroenterol 2021; 44S:100003. [PMID: 33602481 DOI: 10.1016/j.clirex.2020.100003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The reported hepatotoxicity of methotrexate underlines the need for a repeated non-invasive and reliable evaluation of liver fibrosis. We estimated, using a non-invasive strategy, the prevalence of significant liver fibrosis in patients treated by methotrexate and the predictors of significant fibrosis (fibrosis≥F2). METHODS Fibrosis was prospectively evaluated using 9 non-invasive tests in consecutive patients with psoriasis, rheumatoid arthritis, or Crohn's disease. Significant fibrosis was assessed without liver biopsy by defining a "specific method" (result given by the majority of the tests) and a "sensitive method" (at least one test indicating a stage≥F2). RESULTS One hundred and thirty-one patients (66 Psoriasis, 40 rheumatoid arthritis, and 25 Crohn's disease) were enrolled, including 83 receiving methotrexate. Seven tests were performed on average per patient, with a complete concordance in 75% of cases. Fibroscan® was interpretable in only 61% of patients. The best performances (AUROC>0.9) for predicting significant fibrosis were obtained by tests dedicated to steatohepatitis (FibroMeter NAFLD, NFS and FPI). The prevalence of fibrosis≥F2 according to the "specific" or the "sensitive" assessment of fibrosis was 10% and 28%, respectively. Methotrexate exposure did not influence the fibrosis stage. Factors independently associated with significant fibrosis according our "sensitive method" were age, male gender, and metabolic syndrome. CONCLUSION We provided a non-invasive approach for identifying liver fibrosis≥F2 by using 8 biochemical tests and Fibroscan®. In this population, the risk of significant fibrosis was related to age, male gender, and presence of metabolic syndrome, but was not influenced by methotrexate.
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Affiliation(s)
- Jean-Paul Cervoni
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France; CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France.
| | - Blandine Alby-Lepresle
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Delphine Weil
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Peng Zhong
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - François Aubin
- Service de dermatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Daniel Wendling
- Service de rhumatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Eric Toussirot
- CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France; Service de rhumatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Lucine Vuitton
- Service de gastroenterologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Franck Carbonnel
- Service de gastroenterologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | | | - Thierry Thévenot
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Paul Calès
- Service d'hépatologie et de gastroenterologie, CHRU Angers, 49100 Angers, France
| | - Elisabeth Monnet
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France; CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Vincent Di Martino
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
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Güngörer V, Öztürk M, Özlü MY, Arslan Ş. What is the impact of methotrexate on liver in patients with juvenile idiopathic arthritis? Results of liver SWE performed in a single centre. Mod Rheumatol 2021; 32:776-782. [PMID: 34918139 DOI: 10.1093/mr/roab064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Long-term therapy with low-dose methotrexate (MTX) is widely used in treatment of rheumatic diseases, in children. The purpose of this study was to evaluate liver elasticity in patients with juvenile idiopathic arthritis (JIA) who received MTX and compare the results with control group. METHODS Liver elasticity was evaluated with shear wave elastography (SWE) technique in 25 patients aged 3-17 years who were followed up with JIA and received MTX and compared with 25 healthy controls of the same age and weight. Factors that had an effect on liver elasticity were examined. RESULTS The mean SWE value of patients was 2.64 ± 2.13 m/s and 24.10 ± 18.50 kPa, whereas 1.83 ± 0.16 m/s and 10.09 ± 1.83 kPa in control group. There was a significant difference in liver elasticity in the patient and control groups. When the patients were evaluated as Group 1 (< 1000 mg) and Group 2 (≥ 1000 mg) according to the cumulative MTX dose, no significant difference was obtained. There was positive correlation between liver elasticity and weekly MTX dose and age. CONCLUSIONS Our study revealed that liver elasticity significantly decreased in patients who received MTX when compared with the control group. The elastography technique will be understood better over time and used safely in many areas.
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Affiliation(s)
- Vildan Güngörer
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Öztürk
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Yasir Özlü
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Şükrü Arslan
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
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5
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Fujita H, Terui T, Hayama K, Akiyama M, Ikeda S, Mabuchi T, Ozawa A, Kanekura T, Kurosawa M, Komine M, Nakajima K, Sano S, Nemoto O, Muto M, Imai Y, Yamanishi K, Aoyama Y, Iwatsuki K. Japanese guidelines for the management and treatment of generalized pustular psoriasis: The new pathogenesis and treatment of GPP. J Dermatol 2018; 45:1235-1270. [PMID: 30230572 DOI: 10.1111/1346-8138.14523] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 05/01/2024]
Abstract
Generalized pustular psoriasis (GPP) is a rare disease characterized by recurrent fever and systemic flushing accompanied by extensive sterile pustules. The committee of the guidelines was founded as a collaborative project between the Japanese Dermatological Association and the Study Group for Rare Intractable Skin Diseases under the Ministry of Health, Labour, and Welfare Research Project on Overcoming Intractable Diseases. The aim of the guidelines was to provide current information to aid in the treatment of patients with GPP in Japan. Its contents include the diagnostic and severity classification criteria for GPP, its pathogenesis, and recommendations for the treatment of GPP. Since there are few clinical trial data with high levels of evidence for this rare disease, recommendations by the committee are described in the present guidelines.
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Affiliation(s)
- Hideki Fujita
- Division of Dermatological Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tadashi Terui
- Division of Dermatological Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Koremasa Hayama
- Division of Dermatological Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigaku Ikeda
- Department of Dermatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, Isehara, Japan
| | - Akira Ozawa
- Department of Dermatology, Tokai University School of Medicine, Isehara, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Japan
| | | | - Masahiko Muto
- Department of Dermatology, Yamaguchi University School of Medicine, Ube, Japan
| | - Yasutomo Imai
- Department of Dermatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kiyofumi Yamanishi
- Department of Dermatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
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6
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Tang X, Teng S, Liu C, Jagodzinski M. Influence of hydrodynamic pressure on the proliferation and osteogenic differentiation of bone mesenchymal stromal cells seeded on polyurethane scaffolds. J Biomed Mater Res A 2017; 105:3445-3455. [DOI: 10.1002/jbm.a.36197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/21/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Xiangyu Tang
- Department of Radiology; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan P. R. China
| | - Songsong Teng
- Department of Orthopedic Trauma; Hanover Medical School (MHH); Hanover Germany
| | - Chaoxu Liu
- Department of Orthopedics; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan P. R. China
| | - Michael Jagodzinski
- Department of Orthopedic Trauma; Hanover Medical School (MHH); Hanover Germany
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7
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van der Voort E, Wakkee M, Veldt-Kok P, Darwish Murad S, Nijsten T. Enhanced liver fibrosis test in patients with psoriasis, psoriatic arthritis and rheumatoid arthritis: a cross-sectional comparison with procollagen-3 N-terminal peptide (P3NP). Br J Dermatol 2017; 176:1599-1606. [DOI: 10.1111/bjd.15220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/22/2023]
Affiliation(s)
- E.A.M. van der Voort
- Department of Dermatology; Erasmus University Medical Center; Rotterdam The Netherlands
- Department of Dermatology; Groene Hart Hospital; Gouda the Netherlands
| | - M. Wakkee
- Department of Dermatology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - P. Veldt-Kok
- Department of Rheumatology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - S. Darwish Murad
- Department of Gastroenterology and Hepatology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - T. Nijsten
- Department of Dermatology; Erasmus University Medical Center; Rotterdam The Netherlands
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8
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Rongngern P, Chularojanamontri L, Wongpraparut C, Silpa-Archa N, Chotiyaputta W, Pongpaibul A, Charatcharoenwitthaya P. 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 2017; 309:403-408. [DOI: 10.1007/s00403-017-1733-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/24/2017] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
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9
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Cabello Zurita C, Grau Pérez M, Hernández Fernández CP, González Quesada A, Valerón Almazán P, Vilar Alejo J, Carretero Hernández G. Effectiveness and safety of Methotrexate in psoriasis: an eight-year experience with 218 patients. J DERMATOL TREAT 2017; 28:401-405. [DOI: 10.1080/09546634.2016.1273469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Camila Cabello Zurita
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Mercè Grau Pérez
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | | | - Alicia González Quesada
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Pedro Valerón Almazán
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Jaime Vilar Alejo
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Gregorio Carretero Hernández
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
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10
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Tula E, Ergun T, Seckin D, Ozgen Z, Avsar E. Psoriasis and the liver: problems, causes and course. Australas J Dermatol 2016; 58:194-199. [PMID: 26916498 DOI: 10.1111/ajd.12460] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/21/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Psoriasis patients have a higher risk of liver abnormalities such as non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, alcoholic hepatitis and neutrophilic cholangitis, than the general population. Associated liver disease limits therapeutic options and necessitates careful monitoring. The aim of the study was to identify liver problems in psoriasis patients and to investigate the underlying causes as well as their course. METHODS The files of 518 psoriasis patients were retrospectively reviewed. Among these, 393 patients with relevant laboratory data were analysed for liver enzymes and their relation to the known risk factors for liver disease (obesity, diabetes mellitus, alcohol consumption, hepatotoxic medications, dyslipidemia, psoriatic arthritis and infectious hepatitis). RESULTS Among 393 patients, 24% and 0.8% developed liver enzyme abnormalities and cirrhosis, respectively. The most common factors associated with pathological liver enzymes were drugs (57%) and NAFLD (22%). Other rare causes were alcoholic hepatitis, viral hepatitis, neutrophilic cholangitis, autoimmune hepatitis and toxic hepatitis due to herbal therapy. Drug-induced liver enzyme abnormalities were reversible whereas in patients with NAFLD transaminases tended to fluctuate. One patient with herbal medicine-related cirrhosis died of sepsis. CONCLUSION Liver enzyme abnormalities are common in psoriasis patients and are mostly associated with drugs and NAFLD. Although most cases can be managed by avoiding hepatotoxic medications and close follow up, severe consequences like cirrhosis may develop.
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Affiliation(s)
- Elona Tula
- Department of Dermatology, Corlu Vatan Hospital, Tekirdag, Turkey
| | - Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Seckin
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Zuleyha Ozgen
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Erol Avsar
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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11
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Liver Stiffness Measurement in Psoriasis: Do Metabolic or Disease Factors Play the Important Role? BIOMED RESEARCH INTERNATIONAL 2016; 2016:7963972. [PMID: 27006950 PMCID: PMC4781942 DOI: 10.1155/2016/7963972] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/31/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND An increased prevalence of metabolic syndrome including nonalcoholic fatty liver disease (NAFLD) was reported in psoriasis. NAFLD can progress to nonalcoholic steatohepatitis and fibrosis. Transient elastography (TE) is a noninvasive liver fibrosis assessment. We evaluated the prevalence of significant liver fibrosis or high liver stiffness measurement (LSM) using the LSM cutoff over 7 kPa and its associated factors in psoriatic patients. METHODS Subjects underwent TE and ultrasonography. Univariate and multivariate analysis were performed for the associated factors. RESULTS One hundred and sixty-eight patients were recruited. Three patients were excluded due to TE failure. Mean BMI was 24.8 ± 4.7 kg/m(2). NAFLD, metabolic syndrome, and diabetes were seen in 105 (63.6%), 83 (50.3%), and 31 (18.8%) patients. The total cumulative dose of methotrexate over 1.5 g was seen in 39 (23.6%) patients. Mean LSM was 5.3 ± 2.9 kPa. High LSM was found in 18 (11.0%) patients. Waist circumference (OR: 1.24; 95% CI: 1.11-1.38; P = 0.0002), diabetes (OR: 12.70; 95% CI: 1.84-87.70; P = 0.010), and AST (OR: 1.08; 95% CI: 1.02-1.16; P = 0.017) were associated with high LSM. CONCLUSION 11% of psoriatic patients had significant liver fibrosis by high LSM. Waist circumference, diabetes, and AST level were the independent predictors.
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12
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Abstract
In the era of biologic therapies, methotrexate (MTX), a classic immunomodulator, is still the cornerstone of systemic treatment of psoriasis. MTX has been used for many years, achieving good responses with a good safety profile. However, only a few randomized clinical trials have been performed involving MTX, and most of the current evidence comes from pivotal studies of biologic drugs. The aim of this article is to make an extensive review of the MTX mechanism of action, pharmacokinetics, efficacy, safety and tolerability, especially focusing on the future perspective of this old drug and recent advances in the field of pharmacogenetics.
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Affiliation(s)
- Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
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13
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Ferner RE. Adverse drug reactions in dermatology. Clin Exp Dermatol 2015; 40:105-9; quiz 109-10. [PMID: 25622648 DOI: 10.1111/ced.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/21/2022]
Abstract
Adverse drug reactions (ADRs) - that is, unintended and harmful responses to medicines - are important to dermatologists because many present with cutaneous signs and because dermatological treatments can cause serious ADRs. The detection of ADRs to new drugs is often delayed because they have a long latency or are rare or unexpected. This means that ADRs to newer agents emerge only slowly after marketing. ADRs are part of the differential diagnosis of unusual rashes. A good drug history that includes details of drug dose, time-course of the reaction and factors that may make the patient more susceptible, will help. For example, Stevens-Johnson syndrome with abacavir is much commoner in patients with HLA-B*5701, and has a characteristic time course. Newer agents have brought newer reactions; for example, acneiform rashes associated with epidermal growth factor receptor inhibitors such as erlotinib. Older systemic agents used to treat skin disease, including corticosteroids and methotrexate, cause important ADRs. The adverse effects of newer biological agents used in dermatology are becoming clearer; for example, hypersensitivity reactions or loss of efficacy from antibody formation and progressive multifocal leucoencephalopathy due to reactivation of latent JC (John Cunningham) virus infections during efalizumab treatment. Unusual or serious harm from medicines, including ADRs, medication errors and overdose, should be reported. The UK Yellow Card scheme is online, and patients can report their own ADRs.
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Affiliation(s)
- R E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital Birmingham and School of Clinical and Experimental Medicine, Birmingham, UK
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14
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Abstract
Methotrexate is effective not only in treating psoriasis and rheumatoid arthritis but also various other disorders. The use of methotrexate has been somewhat limited by concerns regarding its adverse effects, including its potential for hepatotoxicity. The purpose of this article is to provide an overview of methotrexate-associated hepatotoxicity, including risk factors, pathogenesis and recommendations for monitoring it by US, UK and European guidelines, as well as providing a brief overview of its mechanism of action and of high-dose methotrexate.
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Affiliation(s)
- Roopjeet K Bath
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA
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15
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Maybury C, Samarasekera E, Douiri A, Barker J, Smith C. Diagnostic accuracy of noninvasive markers of liver fibrosis in patients with psoriasis taking methotrexate: a systematic review and meta-analysis. Br J Dermatol 2014; 170:1237-47. [DOI: 10.1111/bjd.12905] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 01/06/2023]
Affiliation(s)
- C.M. Maybury
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - E. Samarasekera
- National Clinical Guideline Centre; Royal College of Physicians of London; 11 St Andrews Place London NW1 4LE U.K
| | - A. Douiri
- Department of Public Health Sciences; School of Medicine; King's College London; Capitol House; 42 Weston St London SE1 3QD U.K
| | - J.N. Barker
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
| | - C.H. Smith
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guys Campus; King's College London; London U.K
- St John's Institute of Dermatology; Guys and St Thomas' NHS Foundation Trust; London U.K
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16
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Martyn-Simmons C, Rosenberg W, Cross R, Wong T, Smith C, Barker J. Validity of noninvasive markers of methotrexate-induced hepatotoxicity: a retrospective cohort study. Br J Dermatol 2014; 171:267-73. [DOI: 10.1111/bjd.12782] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 01/06/2023]
Affiliation(s)
- C.L. Martyn-Simmons
- Division of Genetics and Molecular Medicine; St John's Institute of Dermatology; King's College London and Guy's and St Thomas' NHS Foundation Trust; London U.K
| | - W.M.C. Rosenberg
- Division of Medicine; Institute for Liver and Digestive Health; University College London; London U.K
| | - R. Cross
- iQur Ltd; Wolfson Laboratory; Royal Free Hospital; London U.K
| | - T. Wong
- Department of Gastroenterology; King's College London and Guy's and St Thomas' NHS Foundation Trust; London U.K
| | - C.H. Smith
- Division of Genetics and Molecular Medicine; St John's Institute of Dermatology; King's College London and Guy's and St Thomas' NHS Foundation Trust; London U.K
| | - J.N.W.N. Barker
- Division of Genetics and Molecular Medicine; St John's Institute of Dermatology; King's College London and Guy's and St Thomas' NHS Foundation Trust; London U.K
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Schiavon LDL, Narciso-Schiavon JL, Carvalho-Filho RJD. Non-invasive diagnosis of liver fibrosis in chronic hepatitis C. World J Gastroenterol 2014; 20:2854-2866. [PMID: 24659877 PMCID: PMC3961992 DOI: 10.3748/wjg.v20.i11.2854] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/20/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Assessment of liver fibrosis in chronic hepatitis C virus (HCV) infection is considered a relevant part of patient care and key for decision making. Although liver biopsy has been considered the gold standard for staging liver fibrosis, it is an invasive technique and subject to sampling errors and significant intra- and inter-observer variability. Over the last decade, several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection, with variable performance. Besides the clear advantage of being noninvasive, a more objective interpretation of test results may overcome the mentioned intra- and inter-observer variability of liver biopsy. In addition, these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk. However, in general, these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extra-hepatic conditions. These methods are either serum markers (usually combined in a mathematical model) or imaging modalities that can be used separately or combined in algorithms to improve accuracy. In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C, their advantages, limitations and application in clinical practice.
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Gan EY, Chong WS, Tey HL. Therapeutic strategies in psoriasis patients with psoriatic arthritis: focus on new agents. BioDrugs 2014; 27:359-73. [PMID: 23580094 DOI: 10.1007/s40259-013-0025-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis affects approximately 6-42 % of patients with psoriasis. It is useful for physicians or dermatologists managing psoriasis patients to be aware of how to concurrently manage the joint manifestations, as it is preferable and convenient to use a single agent in such patients. However, only certain therapies are effective for both. Systemic agents, which can be used for both skin and joint manifestations, include methotrexate and ciclosporin. For the group of biologic agents, the tumor necrosis factor inhibitors such as adalimumab, etanercept, infliximab, golimumab and certolizumab are effective. Ustekinumab is a more recently developed agent belonging to the group of anti-IL-12p40 antibodies and has been shown to be efficacious. Newer drugs in the treatment armamentarium that have shown efficacy for both psoriasis and psoriatic arthritis consist of the anti-IL-17 agent, secukinumab, and a phosphodiesterase-4 inhibitor, apremilast. The other anti-IL-17 agents, ixekizumab and brodalumab, as well as the oral Jak inhibitor, tofacitinib, have very limited but promising data. This review paper provides a good overview of the agents that can be used for the concurrent management of skin and joint psoriasis.
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Aktueller Stand der oralen Therapie mit immunmodulatorischen und immunsuppressiven Medikamenten. Hautarzt 2014; 65:89-97. [DOI: 10.1007/s00105-013-2652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Dogra S, Mahajan R. Systemic methotrexate therapy for psoriasis: past, present and future. Clin Exp Dermatol 2013; 38:573-88. [DOI: 10.1111/ced.12062] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 01/20/2023]
Affiliation(s)
- S. Dogra
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh; India
| | - R. Mahajan
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh; India
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Yeo CM, Chong VH, Earnest A, Yang WL. Prevalence and risk factors of methotrexate hepatoxicity in Asian patients with psoriasis. World J Hepatol 2013; 5:275-280. [PMID: 23717738 PMCID: PMC3664285 DOI: 10.4254/wjh.v5.i5.275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish the prevalence of liver fibrosis and to evaluate the possible risk factors for fibrosis and progression in Asian with psoriasis treated with methotrexate (MTX) based on liver histology.
METHODS: Patients with psoriasis treated with MTX referred to the Department of Gastroenterology, Tan Tock Seng Hospital for liver biopsy were identified and retrospectively studied. Patient case notes and electronic records were retrieved from the hospital database and relevant data collated. Histological changes of liver biopsies were staged according to Roengik score. The factors assessed were age, gender, ethnicity, cumulative dose of MTX, presence of comorbid conditions such as diabetes, hypertension, hyperlipidemia, and ethanol use. We also assessed the histological change in those with multiple liver biopsies. Statistical analysis was performed using Stata V.9.2.
RESULTS: There were altogether 59 patients (median age 50 years old, range 22-81 years old, male, 88%) with 98 biopsies liver biopsies; 6 normal [median cumulative dose (MCD), 2285 mg]; 62 grade I (MCD 2885 mg), 23 grade II (MCD 1800 mg) and 7 grade III (MCD 1500 mg). There was no grade IV or cirrhosis. The prevalence of liver fibrosis (grade III) was 12%. Of the factors assessed, diabetes (P = 0.001) and hypertension (P = 0.003) were significant for fibrosis on univariate analysis but not on multivariate analysis. Of the 26 patients who had more than one biopsy (median 2, range 2-6), 57.7% (n = 15) were stable, 34.6% (n = 9) had progression and 7.7% (n = 2) had regression of histological grades. On univariate analysis, non-Chinese ethnicity (P = 0.031), diabetes (P = 0.018), and hyperlipidemia (P = 0.011) were predictive of progression of grades, but these were not significant on multivariate analysis.
CONCLUSION: Liver fibrosis in Asian psoriatic population on MTX is comparable to the West. Cumulative dose was not associated with liver fibrosis. Metabolic syndrome is important factors.
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Abstract
Psoriasis is a common chronic inflammatory disease of the skin that has a significant impact on quality of life. A small number of systemic therapies are well established in psoriasis management. These have immunosuppressive and/or anti-proliferative effects on the skin and immune system. As understanding of the pathogenesis of psoriasis has advanced over the last 2 decades, there has been clearer appreciation of the genetic, cellular and immunological components of disease expression, which has provided new insight into potential therapeutic targets, including the development of biological therapies. Biologics offer a unique opportunity to block or inhibit specific key components of psoriasis pathogenesis. The introduction of tumour necrosis factor (TNF).α and interleukin (IL)-12/-23 inhibitors has resulted in remarkable clinical responses in patients with severe psoriasis and has led to the development of a range of other cytokine modulators currently undergoing investigation. More recently, research in keratinocyte biology and immune cell function, particularly intracellular signalling, has afforded additional opportunities to develop a range of small-molecule oral preparations that may prove effective in disease control. This paper reviews current and emerging systemic treatments in the management of psoriasis.
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Affiliation(s)
- Philip M Laws
- The University of Manchester, Manchester Academic Health Science Centre, Department of Dermatology, Salford Royal Hospital (Hope), Salford, Manchester, UK
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Trifan A, Stanciu C. Checkmate to liver biopsy in chronic hepatitis C? World J Gastroenterol 2012; 18:5514-20. [PMID: 23112543 PMCID: PMC3482637 DOI: 10.3748/wjg.v18.i39.5514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy (LB) has traditionally been considered the gold standard for pretreatment evaluation of liver fibrosis in patients with chronic hepatitis C (CHC). However, LB is an invasive procedure with several shortcomings (intra- and interobserver variability of histopathological interpretation, sampling errors, high cost) and the risk of rare but potentially life-threatening complications. In addition, LB is poorly accepted by patients and it is not suitable for repeated evaluation. Furthermore, the prevalence of CHC makes LB unrealistic to be performed in all patients with this disease who are candidates for antiviral therapy. The above-mentioned drawbacks of LB have led to the development of noninvasive methods for the assessment of liver fibrosis. Several noninvasive methods, ranging from serum marker assays to advanced imaging techniques, have proved to be excellent tools for the evaluation of liver fibrosis in patients with CHC, whereas the value of LB as a gold standard for staging fibrosis prior to antiviral therapy has become questionable for clinicians. Despite significant resistance from those in favor of LB, noninvasive methods for pretreatment assessment of liver fibrosis in patients with CHC have become part of routine clinical practice. With protease inhibitors-based triple therapy already available and substantial improvement in sustained virological response, the time has come to move forward to noninvasiveness, with no risks for the patient and, thus, no need for LB in the assessment of liver fibrosis in the decision making for antiviral therapy in CHC.
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Reich K, Domm S, Mrowietz U. Methotrexate therapy in dermatology. J Dtsch Dermatol Ges 2012; 10:363-70. [DOI: 10.1111/j.1610-0387.2012.07926.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bray APJJ, Barnova I, Przemioslo R, Kennedy CTC. Liver fibrosis screening for patients with psoriasis taking methotrexate: a cross-sectional study comparing transient elastography and liver biopsy. Br J Dermatol 2012; 166:1125-7. [PMID: 21967341 DOI: 10.1111/j.1365-2133.2011.10657.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Arena U, Stasi C, Mannoni A, Benucci M, Maddali-Bongi S, Cammelli D, Assarat A, Marra F, Pinzani M. Liver stiffness correlates with methotrexate cumulative dose in patients with rheumatoid arthritis. Dig Liver Dis 2012; 44:149-53. [PMID: 21930442 DOI: 10.1016/j.dld.2011.08.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/03/2011] [Accepted: 08/14/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver stiffness values were recently proposed to identify patients with methotrexate-induced liver fibrosis. Aim of this study was to assess the clinical and laboratory determinants of the association between liver stiffness, measured by transient elastography, and methotrexate treatment in patients with rheumatoid arthritis in the absence of other factors contributing to liver damage and fibrosis. METHODS 100 patients with rheumatoid arthritis, with a cumulative methotrexate dose ranging from 1530 to 13,000 mg over a mean period of 7.07±3.89 yrs, were retrospectively evaluated. RESULTS The average liver stiffness value in the whole population was 4.93±1.8 kPa, excluding the presence of significant fibrosis. At univariate analysis, a significant correlation was found between liver stiffness and methotrexate cumulative dose, duration of treatment, alanine transaminases levels, body mass index, gamma glutamyl-transpeptidase and the presence of steatosis. At multivariate analysis, a significant association was detected only between liver stiffness and methotrexate cumulative dose. Out of 11 patients with liver stiffness >7.0 kPa, five were subjected to liver biopsy and mild or moderate perisinusoidal fibrosis was detected in two patients with a cumulative dose >4000 mg and liver stiffness >9 kPa. CONCLUSIONS Chronic methotrexate treatment induces a progressive increase in liver stiffness corresponding to mild or moderate perisinusoidal fibrosis for values >9 kPa.
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Affiliation(s)
- Umberto Arena
- Dipartimento di Medicina Interna, Università degli Studi di Firenze/Azienda Ospedaliero Universitaria Careggi (AOUC), Firenze, Italy
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Liu C, Abedian R, Meister R, Haasper C, Hurschler C, Krettek C, von Lewinski G, Jagodzinski M. Influence of perfusion and compression on the proliferation and differentiation of bone mesenchymal stromal cells seeded on polyurethane scaffolds. Biomaterials 2012; 33:1052-64. [DOI: 10.1016/j.biomaterials.2011.10.041] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/17/2011] [Indexed: 12/20/2022]
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28
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Shen S, O’Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol 2011; 53:1-18. [DOI: 10.1111/j.1440-0960.2011.00839.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gupta SK, Singh KK, Lalit M. Comparative therapeutic evaluation of different topicals and narrow band ultraviolet B therapy combined with systemic methotrexate in the treatment of palmoplantar psoriasis. Indian J Dermatol 2011; 56:165-70. [PMID: 21716541 PMCID: PMC3108515 DOI: 10.4103/0019-5154.80410] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: The incidence of uncomplicated psoriasis is 1–3% in the general population. The involvement of palm and sole is seen in 7–14.5% of cases. There are different topicals and systemic therapies available for treating the case of psoriasis but none is satisfactory for longer duration. Aim: The study involved the comparative therapeutic evaluation of the different topical regimens and narrow band ultraviolet B (NB-UVB) therapy in combination with systemic methotrexate. Materials and Methods: The study was held in out-patient department of Skin, VD and Leprosy of B.R.D. Medical College, Gorakhpur, from July 2007 to December 2008. The group included 98 new cases of palmoplantar psoriasis. These cases were divided into eight groups according to the eight regimens involved in the study. The severity of psoriasis was assessed by the ESIF (erythema, scaling, induration and fissuring) score. Results: The study showed that all the regimens had significant response rates. The combination of NB-UVB with systemic methotrexate had maximum response rate (64.85±4.52%) that was statistically significant (paired “t” at 16d.f. = 33.329, P<0.001) with minimum number of recurrences after stopping the treatment. The combination of halobetasol ointment with systemic methotrexate also had significant response rate (paired “t” at 19d.f. = 13.5183, P<0.001) but had maximum number of cases with recurrence (70%) after stopping the treatment. Conclusion: These results suggest that the combination of every regimen with systemic methotrexate resulted in an early and a good improvement in the quality of life of patients suffering from psoriasis. It also shows that NB-UVB in combination with systemic methotrexate is more efficacious and has minimum recurrence rate and side effects in the treatment of palmoplantar psoriasis.
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Affiliation(s)
- Sunil K Gupta
- Department of Skin, V.D. and Leprosy, B.R.D. Medical College, Gorakhpur, India
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30
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JYM, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol 2011; 65:137-74. [PMID: 21306785 DOI: 10.1016/j.jaad.2010.11.055] [Citation(s) in RCA: 310] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 11/21/2010] [Accepted: 11/26/2010] [Indexed: 12/13/2022]
Abstract
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the American Academy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients' needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.
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Affiliation(s)
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- Psoriasis Research Center, Baylor University Medical Center, Dallas, Texas, USA
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Abstract
Antirheumatic agents are among commonly used drugs associated with adverse hepatic reactions. Sulfasalazine and azathioprine are among the most important causes of acute hepatotoxicity. Because such a large number of people take NSAIDs, even the rare occurrence of hepatotoxicity from these agents might contribute substantially to the total burden of drug-induced liver disease. A wide spectrum of hepatotoxic effects is described with antirheumatic drugs. Studies investigating genetic susceptibility to diclofenac hepatotoxicity have expanded our understanding of the potential drug-specific, class-specific and general factors involved in its pathogenesis, and methotrexate-associated liver disease demonstrates the interaction between drug, host and environmental factors that determines the likelihood and magnitude of liver disease. Infliximab therapy is associated with typical drug-induced autoimmune hepatitis. Although validated causality assessment methods have been used to objectively assess the strength of the association between a drug and a clinical event, in practice the diagnosis of drug-induced liver injury (DILI) involves a clinical index of suspicion, pattern recognition, the establishment of a temporal relationship between drug exposure and the adverse event, and the exclusion of alternative explanations for the clinical presentation. Detailed understanding of genetic and environmental factors underlying an individual's susceptibility would enable risk reduction and potentially primary prevention of hepatotoxicity.
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Affiliation(s)
- Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, National Institute of Health Research Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, UK.
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Abstract
Psoriasis, a chronic multifactorial inflammatory disease that develops in genetically predisposed individuals, affects approximately 1.5% of the Spanish population. This disease has a negative impact on patients' quality of life, and long-term therapy is often required to control the symptoms. In addition to the classical systemic treatments (methotrexate, acitretin, cyclosporine, and ultraviolet light), the group of drugs known as biologics (etanercept, infliximab, adalimumab, and ustekinumab) provides the dermatologist with an expanded therapeutic armamentarium, thereby improving the likelihood of controlling psoriasis in patients with severe and/or extensive disease. Methotrexate, a classic antipsoriatic drug, is still very useful either as single-drug therapy or in combination with other systemic drugs, particularly as a rescue therapy or combined with biologics. This article aims to establish the role of methotrexate in the treatment of psoriasis. We considered it of interest to develop guidelines for using methotrexate in the management of psoriasis with a view to ensuring the safe and proper use of this drug in the management of psoriasis. This document was developed by consensus among members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology.
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Barker J, Horn EJ, Lebwohl M, Warren RB, Nast A, Rosenberg W, Smith C. Assessment and management of methotrexate hepatotoxicity in psoriasis patients: report from a consensus conference to evaluate current practice and identify key questions toward optimizing methotrexate use in the clinic. J Eur Acad Dermatol Venereol 2010; 25:758-64. [PMID: 21198946 DOI: 10.1111/j.1468-3083.2010.03932.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Experts in psoriasis, hepatology, pharmacokinetics and pharmacogenetics convened to discuss the safety and monitoring of methotrexate with respect to hepatotoxicity when used in the treatment of psoriasis. Methotrexate is an efficacious and cost-effective treatment for psoriasis, but is associated with significant safety issues, particularly relating to hepatotoxicity. Current British, Dutch, German, EU and US guidelines for baseline evaluations, monitoring and prevention of hepatotoxicity in patients with psoriasis receiving methotrexate were evaluated. Liver safety monitoring is currently reliant upon multiple methods, including biopsy, serological tests for biomarkers such as type III procollagen amino terminal propeptide (PIIINP), and liver function tests based on liver enzymes. Monitoring of patients receiving long-term therapy is expected to be improved by the utilization of serum biomarkers currently in development such as the Enhanced Liver Fibrosis (ELF) panel and other non-invasive tests of hepatic architecture, such as fibroelastography, microbubbles and magnetic resonance imaging. Appropriate studies to determine optimal dosing to maximize efficacy and minimize toxicity, potentially utilizing pharmacogenetic principles, are clearly needed. Key questions for future research are identified including needs for optimal screening and monitoring, identification of appropriate biomarkers, assessment of relationships between dosing and safety, utility of liver biopsy, optimal dosing regimens (including route of administration), methods to measure methotrexate levels in blood, and use of methotrexate as a standardized active comparator in trials of experimental drugs used to treat psoriasis.
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Affiliation(s)
- J Barker
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Kings College, London, UK.
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34
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Metotrexato: guía de uso en psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2010; 101:600-613. [DOI: 10.1016/j.ad.2010.04.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/21/2010] [Indexed: 12/31/2022] Open
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Boehncke WH, Katsambas A, Ortonne JP, Puig L. EADV preceptorship: advances in dermatology. J Eur Acad Dermatol Venereol 2010; 24 Suppl 5:2-24. [DOI: 10.1111/j.1468-3083.2010.03787.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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36
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Laws PM, Young HS. Update of the management of chronic psoriasis: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol 2010; 3:25-37. [PMID: 21437057 PMCID: PMC3047953 DOI: 10.2147/ccid.s6497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Indexed: 01/01/2023]
Abstract
Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options.
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Affiliation(s)
- Philip M Laws
- The University of Manchester, Manchester Bioscience and Academic Health Sciences Centre, Department of Dermatology, Salford Royal Hospital (Hope), Manchester, UK
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37
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Laws P, Barton A, Warren RB. Psoriatic arthritis - what the dermatologist needs to know. J Eur Acad Dermatol Venereol 2010; 24:1270-7. [DOI: 10.1111/j.1468-3083.2010.03654.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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38
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Abstract
Percutaneous liver biopsy (LB) remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever-increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances.
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Affiliation(s)
- Faisal M. Sanai
- Hepatology Unit, Department of Medicine, Riyadh Military Hospital; Liver Disease Research Center – King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Faisal M. Sanai, Division of Gastroenterology and Hepatology (A41), Department of Medicine, Riyadh Military Hospital, PO Box 7897, Riyadh-11159, Saudi Arabia. E-mail:
| | - Emmet B. Keeffe
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
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Actualités sur le psoriasis à l’EADV. Ann Dermatol Venereol 2009. [DOI: 10.1016/s0151-9638(09)73611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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40
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Driessen R, Van De Kerkhof P, De Jong E. Daily practice assessment of liver injury in patients with psoriasis on methotrexate. Br J Dermatol 2009; 162:211-3. [DOI: 10.1111/j.1365-2133.2009.09498.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lindsay K, Gough A, Layton A, Fraser S. Comment on: Liver fibrosis in patients with psoriasis and psoriatic arthritis on long term, high cumulative dose methotrexate therapy: reply. Rheumatology (Oxford) 2009. [DOI: 10.1093/rheumatology/kep259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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42
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Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret L, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Hönigsmann H, Hussain M, Jobling R, Karvonen SL, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne JP, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H, Thio HB, van de Kerkhof P, Rzany B. European S3-Guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009; 23 Suppl 2:1-70. [DOI: 10.1111/j.1468-3083.2009.03389.x] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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43
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Gürcan H, Razzaque Ahmed A. Analysis of current data on the use of methotrexate in the treatment of pemphigus and pemphigoid. Br J Dermatol 2009; 161:723-31. [DOI: 10.1111/j.1365-2133.2009.09246.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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44
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Boffa MJ, Smith A, Chalmers RJG. Comment on: Liver fibrosis in patients with psoriasis and psoriatic arthritis on long-term, high cumulative dose methotrexate therapy. Rheumatology (Oxford) 2009; 48:1464; author reply 1465. [DOI: 10.1093/rheumatology/kep238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dubertret L, Chimenti S, Christophers E, Daudén E, de Rie M, Griffiths CEM, Kragballe K, Ståhle M, Stingl G. Alice, Eloi, Magali and Robert: the lives of four patients with psoriasis and the therapeutic approaches of eight European experts. Br J Dermatol 2009; 161 Suppl 2:1-30. [DOI: 10.1111/j.1365-2133.2009.09173.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb AB, Koo JYM, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009; 61:451-85. [PMID: 19493586 DOI: 10.1016/j.jaad.2009.03.027] [Citation(s) in RCA: 355] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 03/23/2009] [Accepted: 03/25/2009] [Indexed: 01/19/2023]
Abstract
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fourth of 6 sections of the guidelines of care for psoriasis, we discuss the use of traditional systemic medications for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety, and offer recommendations for the use of the 3 most commonly used, and approved, traditional systemic agents: methotrexate, cyclosporine, and acitretin. We will also briefly discuss the available data for the use of azathioprine, fumaric acid esters, hydroxyurea, leflunomide, mycophenolate mofetil, sulfasalazine, tacrolimus, and 6-thioguanine in psoriasis.
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Affiliation(s)
- Alan Menter
- Baylor University Medical Center, Dallas, Texas, USA
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Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 2009; 60:824-37. [PMID: 19389524 DOI: 10.1016/j.jaad.2008.11.906] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 11/17/2008] [Accepted: 11/19/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Methotrexate remains a valuable option for the treatment of psoriasis. This report will summarize studies regarding the use of methotrexate since the last guidelines were published in 1998. OBJECTIVE A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to achieve a consensus on new updated guidelines for the use of methotrexate in the treatment of psoriasis. METHODS Reports in the literature were reviewed regarding methotrexate therapy. RESULTS A consensus was achieved on use of methotrexate in psoriasis including specific recommendations on dosing and monitoring. The consensus received unanimous approval from members of the Medical Board of the National Psoriasis Foundation. LIMITATIONS There are few evidence-based studies on the treatment of psoriasis with methotrexate. Many of the reviewed reports are for the treatment of rheumatoid arthritis. CONCLUSIONS Methotrexate is a safe and effective drug for the treatment of psoriasis. Appropriate patient selection and monitoring will significantly decrease the risks of side effects. In patients without risk factors for hepatic fibrosis, liver biopsies may not be indicated or the frequency of liver biopsies may be markedly reduced.
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Affiliation(s)
- Robert E Kalb
- Department of Dermatology: State University of New York at Buffalo, School of Medicine and Biomedical Science, Buffalo, New York, USA
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Warren RB, Chalmers RJG, Griffiths CEM, Menter A. Methotrexate for psoriasis in the era of biological therapy. Clin Exp Dermatol 2008; 33:551-4. [DOI: 10.1111/j.1365-2230.2008.02976.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Van Leeuwen DJ, Balabaud C, Crawford JM, Bioulac-Sage P, Dhillon AP. A clinical and histopathologic perspective on evolving noninvasive and invasive alternatives for liver biopsy. Clin Gastroenterol Hepatol 2008; 6:491-6. [PMID: 18455694 DOI: 10.1016/j.cgh.2008.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 01/31/2008] [Accepted: 02/04/2008] [Indexed: 02/07/2023]
Abstract
Noninvasive or minimally invasive alternatives are proposed as substitutes for liver biopsy and include clinical indices, cross-sectional imaging, serum biomarkers, liver stiffness measurement, and portal pressure measurement. Most alternatives to liver biopsy assess one aspect of liver disease and translate this into a numeric score. Overlap between categories may limit applications. Liver biopsy provides information about numerous variables: tissue architectural changes; necroinflammatory injury; fibrotic stage; alterations of parenchyma and bile duct epithelium; accumulation of fat, copper, and iron; and molecular and genetic changes. Liver biopsy may identify multiple disease etiologies. A single numeric score cannot be a substitute for complete histologic assessment. However, within defined clinical contexts, noninvasive assessment is an attractive alternative for many patients given the ease, avoidance of risk from invasive procedures, and validated contribution to clinical management. Serum biomarkers and liver stiffness assessment may become indispensable in longitudinal studies and to document outcome of treatments. The accuracy of the more reliable techniques is typically around 80%. Neither liver biopsy nor any single alternative option represents an absolute assessment of liver disease. Biopsy and alternatives are not mutually exclusive options. Liver biopsy and the noninvasive alternatives require a clear understanding of significance and limitations of each investigation. This places a responsibility on the clinician to consider fully the results of any of the investigative options used within the diagnostic and prognostic context of each individual patient, and to choose critically the most appropriate investigations for the patient's needs.
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Affiliation(s)
- Dirk J Van Leeuwen
- Section of Gastroenterology and Hepatology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire 03756, USA.
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Manning DS, Afdhal NH. Diagnosis and quantitation of fibrosis. Gastroenterology 2008; 134:1670-81. [PMID: 18471546 DOI: 10.1053/j.gastro.2008.03.001] [Citation(s) in RCA: 300] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/25/2008] [Accepted: 03/03/2008] [Indexed: 12/22/2022]
Abstract
Hepatic fibrosis is the final common pathway for many different liver insults. Originally considered to be irreversible, hepatic fibrosis is now known to be a dynamic process with a significant potential for resolution. The diagnosis and quantitation of fibrosis have traditionally relied on liver biopsy. However, there are a number of drawbacks including the invasive nature of the procedure, sampling error, and interobserver variability. This article reviews the current role of liver biopsy in the assessment of hepatic fibrosis and discusses the role of the newer noninvasive methods including serum markers and radiologic tests.
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Affiliation(s)
- Diarmuid S Manning
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts, USA
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