Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography

Mahajan, Rahul; Dogra, Sunil; Handa, Sanjeev; Razmi, T Muhammed; Narang, Tarun; Rathi, Sahaj; Dhiman, Radha K.; Saikia, Biman; Karim, Adil

doi:10.4103/ijdvl.ijdvl_152_19

Cited by 5 publications

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“…To note, an Indian study (n = 134) found that MetS and female gender contributed more significantly to the development of liver fibrosis than methotrexate exposure. 72 …”

Section: Resultsmentioning

confidence: 99%

“…To note, an Indian study (n = 134) found that MetS and female gender contributed more significantly to the development of liver fibrosis than methotrexate exposure. 72 Other comorbidities with potentially different distribution between sexes in psoriasis are Crohn's disease, higher in women than in men, while the opposite could be true for ulcerative colitis, 73 nonpsoriatic urogenital inflammation, especially in men (OR = 3.47 with urethritis and prostatitis 74 ), infections, especially in women with psoriatic arthritis (adjusted OR for male vs female = 0.47 75 ), osteoporosis, more frequent in men, 76 contact hypersensitivity, more frequent in women (27.7% vs 5.8% 77 ), avascular necrosis (higher risk in men than in women, with adjusted HR = 2.20 78 ), subclinical hypothyroidism (more frequent in women) and viral hepatitis (in men 10 ).…”

Section: Comorbiditiesmentioning

confidence: 99%

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Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists

Gonzalez-Cantero,

Constantin,

Dattola

et al. 2023

International Journal of Women’s Dermatology

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Background: The prevalence of psoriasis is similar between men and women; however, evidence exists of sex- and gender-related differences in disease expression, impact, coping, and needs of patients with psoriasis. These differences are essential and should be considered in clinical practice and research. Objective: To compile available evidence on sex- and gender-related differences in psoriasis, identify the most critical gaps in clinical practice and research, and use it to propose strategies for improved clinical practice. Methods: Six European dermatologists selected the topics to consider according to their relevance in the dermatology setting with the support of methodologists. Evidence on sex- and gender-related differences was obtained by a scoping review based on search strategies in Medline and Cochrane Library from inception to October 2021 using the following terms: arthritis, psoriatic, psoriasis, gender, and sex. The panel discussed the results and proposed strategies by consensus. Results: The scoping review identified broad themes: (1) clinical expression, (2) severity and patient-reported outcomes, (3) psychosocial impact, (4) access to treatments and propensity to treat, (5) comorbidities, and (6) treatment effect. The strategies are based on these broad themes. Limitations: No risk of bias assessment was done due to the scoping nature of the review. Conclusion: This review offers insights into gender differences in psoriasis, providing a foundation for improving clinical practice and patient outcomes.

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“…To note, an Indian study (n = 134) found that MetS and female gender contributed more significantly to the development of liver fibrosis than methotrexate exposure. 72 …”

Section: Resultsmentioning

confidence: 99%

Section: Comorbiditiesmentioning

confidence: 99%

Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists

Gonzalez-Cantero,

Constantin,

Dattola

et al. 2023

International Journal of Women’s Dermatology

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Review of existing evidence demonstrates that methotrexate does not cause liver fibrosis

Cheema

Haselow

2022

Journal of Investigative Medicine

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It has long been believed that methotrexate in therapeutic doses causes progressive liver injury resulting in advanced fibrosis and cirrhosis. Historically, this was a common indication for serial liver biopsy. However, new evidence suggests that methotrexate may not be a direct cause of liver injury; rather the injury and fibrosis attributed to methotrexate may be mediated by other mechanisms, specifically non-alcoholic fatty liver disease. The recent widespread use of non-invasive assessment of liver fibrosis has provided new evidence supporting this hypothesis. Thus, we conducted a meta-analysis and systematic review to determine whether methotrexate is indeed a direct cause of liver injury. For the meta-analysis portion, a comprehensive literature search was performed to identify manuscripts relevant to the topic. Of the 138 studies examined, 20 met our inclusion criteria. However, only 3 studies had sufficient homogeneity to allow aggregation. Thus, the remainder of the study was dedicated to a critical review of all studies relevant to the topic with particular attention to populations examined, risk factors, and assessment of injury and/or fibrosis. Meta-analysis did not show a statistically significant association between methotrexate dose and liver fibrosis. Individual studies reported fibrosis related to confounding factors such as diabetes, obesity, pre-existing chronic liver disease but not methotrexate exposure. In conclusion, existing evidence demonstrates that advanced liver fibrosis and cirrhosis previously attributed to methotrexate are in fact caused by metabolic liver disease or other chronic liver diseases, but not by methotrexate itself. This observation should direct the care of patients treated with long-term methotrexate.

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Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis

et al. 2022

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BackgroundPatients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients.ObjectiveTo evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis.MethodsElectronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included.ResultsPatients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92–12.75%, I2 = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23–82.05%, I2 = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17–9.22%, I2 = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02–20.08%, I2 = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42–3.40, I2 = 0%), 3.67 (95% CI: 2.37–5.68, I2 = 48.8%), 6.23 (95% CI: 4.39–8.84, I2 = 42.4%), 2.82 (95% CI: 1.68–4.74, I2 = 0%), 3.08 (95% CI: 1.90–4.98, I2 = 0%), and 5.98 (95% CI: 3.63–9.83, I2 = 17%), respectively.ConclusionApproximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].

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Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography

Cited by 5 publications

References 0 publications

Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists

Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists

Review of existing evidence demonstrates that methotrexate does not cause liver fibrosis

Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis

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