Long-term methotrexate (MTX) use among patients with psoriasis who have chronic viral hepatitis is not associated with an increased risk for liver cirrhosis, according to real-world data derived from the results of a nationwide, population-based cohort study conducted in Taiwan and published in the Journal of the American Academy of Dermatology.

The investigators sought to explore the effect of long-term MTX treatment on the risk for chronic viral hepatitis-related cirrhosis among a cohort of patients with psoriasis. Data were obtained from the National Health Insurance Research Database in Taiwan. A total of 2417 patients with psoriasis and chronic hepatitis B (CHB), 370 of whom were MTX users and 2047 of whom were nonusers, were identified.

Moreover, a total of 1127 patients with psoriasis and chronic hepatitis C (CHC), 174 of whom were MTX users and 953 of whom were nonusers, were identified as well. All data were obtained between January 1, 2000, and December 31, 2010.

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After a mean follow-up of >9 years since being diagnosed with chronic viral hepatitis, liver cirrhosis developed in 5% (125 of 2417) of patients with CHB and 11% (120 of 1127) of those with CHC. The proportion of patients in whom liver cirrhosis developed was comparable among MTX users and nonusers (4% vs 5%, respectively, in patients with CHB and 11% vs 11%, respectively, in those with CHC; P <.05 for both).

Multivariate analysis with Cox proportional hazards model identified certain risk factors for liver cirrhosis among patients with psoriasis and chronic viral hepatitis.

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Older age at diagnosis of viral hepatitis was considered a risk factor for liver cirrhosis among those with CHB (hazard ratio [HR] 1.04; 95% CI, 1.03-1.05) and those with CHC (HR 1.03; 95% CI, 1.02-1.05). The prescribing of hepatitis B medication was associated with a higher risk for liver cirrhosis among patients with CHB (HR 8.16; 95% CI, 5.69-11.7). A longer interval between psoriasis diagnosis and development of chronic viral hepatitis was linked with a lower risk for liver cirrhosis.

Limitations of the current study include possible selection bias and medication nonadherence.

The investigators concluded that real-world data have demonstrated no rise in the development of incident liver cirrhosis among patients with psoriasis and either CHB or CHC who have received long-term MTX therapy.


Tang KT, Chen YM, Chang SN, Lin CH, Chen DY. Psoriatic patients with chronic viral hepatitis do not have an increased risk of liver cirrhosis despite long-term methotrexate use: real-world data from a nationwide cohort study in Taiwan [published online May 9, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.004

This article originally appeared on Dermatology Advisor