Methotrexate and liver biopsies. Is it really necessary?

Article Abstract:

Psoriasis is a common, chronic skin disease, characterized by reddened papules, or pimple-like lesions, which join to form plaques or patches that later develop into scaly lesions. The lesions can develop at any site, although the scalp, knees, elbows, umbilicus or abdominal area, and genitals are most often affected. Less than 50 percent of patients experience long-term remission, and disease severity may vary from a cosmetic problem to a life-threatening condition. Arthritis, or joint inflammation, develops in five percent of patients with psoriasis. Psoriasis may be treated with the anticancer agent methotrexate. However, studies have shown that methotrexate may have adverse effects on liver function. Biopsy or sampling of liver tissue was recommended before and each year after the start of methotrexate therapy. Liver function was shown to be normal in persons with fibrosis or fiber formation and fatty accumulation in the liver. Factors that increased the liver damage associated with methotrexate included obesity, increased age, alcohol intake, the dose of methotrexate, and a daily oral medication schedule. Methotrexate is currently used more often in treating patients with rheumatoid arthritis (RA), an inflammatory joint disease, although the incidence of tissue fibrosis is lower in RA patients than in patients with psoriasis. Studies have shown that liver function tests, liver scans, and other noninvasive tests are not as effective as liver biopsy in detecting methotrexate-related liver damage. Thus, it is essential that patients receiving methotrexate treatment undergo biopsy to prevent methotrexate-related liver damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methotrexate, editorial

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Short-term changes in renal function, blood pressure, and electrolyte levels in patients receiving cyclosporine for dermatologic disorders

Article Abstract:

Cyclosporine has been used for almost 20 years to prevent rejection of transplanted organs, but it has also been used to treat skin diseases, as well as autoimmune and other disorders. The potential for kidney damage resulting from cyclosporine therapy has been difficult to measure because of the many other complications usually present in the case of transplant patients. To reduce the complexity of making this determination, a total of 49 patients being treated with cyclosporine for psoriasis, a skin condition, were monitored. One group was observed for one month, and the other for one to three months. A significant decline in kidney function was found among the patients, and there is a potential cumulative effect of the drug that does not depend on either dose or drug levels. All of these changes were reversible, and none of the patients had irreversible kidney problems after stopping drug therapy, but two of the patients in the shorter-term group still had a marked decline in kidney function four weeks after therapy. The risk-benefit ratio in nontransplant patients must be carefully considered when sustained use of cyclosporine is proposed. Although no cases occurred in the study, some patients may have individual adverse reactions. Hypertension resulting from therapy was mild, responded to therapy, and eventually returned to normal when cyclosporine therapy was stopped. Cyclosporine also produced abnormally high levels of potassium, magnesium, and uric acid, all of which returned to normal. Guidelines for safe drug levels and duration of treatment will be determined from the results of long-term trials now in progress. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Complications and side effects, Physiological aspects, Kidneys, Cyclosporine, Cyclosporins, Kidney, Dermatologic agents, Electrolytes

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