No association between methotrexate and increased liver cirrhosis: study on rheumatoid arthritis patients with chronic hepatitis B
Methotrexate (MTX) is a commonly used immunosuppressant in the treatment of many autoimmune diseases such as rheumatoid arthritis (RA), psoriasis and psoriatic arthritis. MTX has been regarded as the anchor drug in the treatment of RA. It has been reported that long-term methotrexate (MTX) use exacerbates liver fibrosis and even leads to liver cirrhosis in RA patients.
A study has been conducted to investigate the impact of long term MTX use on the risk of chronic hepatitis B related cirrhosis among RA patients. A population based cohort study was conducted. Data was analyzed from the National Health Insurance Research Database in Taiwan and 631 incident cases of RA were identified among chronic hepatitis B patients (358 MTX users and 273 MTX non-users) from January 1, 1998 to December 31, 2007.
After the evaluation of data, a median follow-up of more than 6 years of diagnosis of chronic hepatitis B, a total of 41 i.e. 6.5% of patients developed liver cirrhosis. However, increased risk of liver cirrhosis was not noticed among chronic hepatitis B patients with long term use of methotrexate for RA.
Furthermore, there was no occurrence of liver cirrhosis among 56 MTX users with cumulative dose ≧3 grams after 97 months of treatment. After the trial, it was concluded that long term use of MTX was not associated with an increased risk for liver cirrhosis among RA patients with chronic hepatitis B. however, interpretation of the results should be cautious due to potential bias in the cohort.