Skip to main content
British Medical Journal logoLink to British Medical Journal
. 1972 Mar 11;1(5801):654–656. doi: 10.1136/bmj.1.5801.654

Methotrexate Hepatotoxicity in Psoriasis—Comparison of Different Dose Regimens

M G C Dahl, M M Gregory, P J Scheuer
PMCID: PMC1787742  PMID: 5015292

Abstract

Liver histological appearances were studied in 44 patients treated for psoriasis with methotrexate. Cirrhosis was found in six and hepatic fibrosis in another 11. Of these 17 patients 12 had received methotrexate by a regimen of frequent small dosage, two had been treated by a regimen of intermittent large dosage, while three had been treated at different times by both methods. The prevalence of cirrhosis and fibrosis was significantly greater in patients treated by frequent small dosage than in those treated by intermittent large dosage, though the dose level (mg/month) was similar in both groups. Hepatic fibrosis, sometimes preceding cirrhosis, seems to develop invariably if treatment with small frequent dosage is sufficiently prolonged. In the few circumstances in which this drug is indicated for psoriasis intermittent large dosage is the treatment regimen of choice.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almeyda J., Barnardo D., Baker H. Drug reactions XV. Methotrexate, psoriasis and the liver. Br J Dermatol. 1971 Sep;85(3):302–305. doi: 10.1111/j.1365-2133.1971.tb07237.x. [DOI] [PubMed] [Google Scholar]
  2. Baker H. Intermittent high dose oral methotrexate therapy in psoriasis. Br J Dermatol. 1970 Jan;82(1):65–69. doi: 10.1111/j.1365-2133.1970.tb02194.x. [DOI] [PubMed] [Google Scholar]
  3. COLSKY J., GREENSPAN E. M., WARREN T. N. Hepatic fibrosis in children with acute leukemia after therapy with folic acid antagonists. AMA Arch Pathol. 1955 Feb;59(2):198–206. [PubMed] [Google Scholar]
  4. Coe R. O., Bull F. E. Cirrhosis associated with methotrexate treatment of psoriasis. JAMA. 1968 Nov 11;206(7):1515–1520. [PubMed] [Google Scholar]
  5. Dahl M. G., Gregory M. M., Scheuer P. J. Liver damage due to methotrexate in patients with psoriasis. Br Med J. 1971 Mar 20;1(5750):625–630. doi: 10.1136/bmj.1.5750.625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dubin H. V., Harrell E. R. Liver disease associated with methotrexate treatment of psoriatic patients. Arch Dermatol. 1970 Nov;102(5):498–503. [PubMed] [Google Scholar]
  7. Epstein E. H., Jr, Croft J. D., Jr Cirrhosis following methotrexate administration for psoriasis. Arch Dermatol. 1969 Nov;100(5):531–534. [PubMed] [Google Scholar]
  8. HUTTER R. V., SHIPKEY F. H., TAN C. T., MURPHY M. L., CHOWDHURY M. Hepatic fibrosis in children with acute leukemia: a complication of therapy. Cancer. 1960 Mar-Apr;13:288–307. doi: 10.1002/1097-0142(196003/04)13:2<288::aid-cncr2820130213>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  9. Hersh E. M., Wong V. G., Henderson E. S., Freireich E. J. Hepatotoxic effects of methotrexate. Cancer. 1966 Apr;19(4):600–606. doi: 10.1002/1097-0142(196604)19:4<600::aid-cncr2820190420>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  10. MENGHINI G. One-second needle biopsy of the liver. Gastroenterology. 1958 Aug;35(2):190–199. [PubMed] [Google Scholar]
  11. McDonald C. J., Bertino J. Parenteral methotrexate for psoriasis. Lancet. 1968 Apr 20;1(7547):864–864. doi: 10.1016/s0140-6736(68)90332-2. [DOI] [PubMed] [Google Scholar]
  12. Muller S. A., Farrow G. M., Martalock D. L. Cirrhosis caused by methotrexate in the treatment of psoriasis. Arch Dermatol. 1969 Nov;100(5):523–530. [PubMed] [Google Scholar]
  13. O'ROURKE R. A., ECKERT G. E. METHOTREXATE-INDUCED HEPATIC INJURY IN AN ADULT. A CASE REPORT. Arch Intern Med. 1964 Feb;113:191–194. doi: 10.1001/archinte.1964.00280080027006. [DOI] [PubMed] [Google Scholar]
  14. Rees R. B., Bennett J. H., Maibach H. I., Arnold H. L. Methotrexate for psoriasis. Arch Dermatol. 1967 Jan;95(1):2–11. [PubMed] [Google Scholar]
  15. Sharp H., Nesbit M., White J., Krivit W. Methotrexate liver toxicity. J Pediatr. 1969 May;74(5):818–819. doi: 10.1016/s0022-3476(69)80160-5. [DOI] [PubMed] [Google Scholar]
  16. Weinstein G. D., Cox J. W., Suringa D. W., Millard M. M., Kalser M., Frost P. Evaluation of possible chronic hepatotoxicity from methotrexate for psoriasis. Arch Dermatol. 1970 Dec;102(6):613–618. [PubMed] [Google Scholar]
  17. Zachariae H., Schiodt T. Liver biopsy in methotrexate treatment. Acta Derm Venereol. 1971;51(3):215–220. [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES