Hepatotoxicity of long-term methotrexate therapy for psoriasis

Eighty-eight patients with severe psoriasis, 69 of whom had been treated with methotrexate, were studied by liver biopsy. Cirrhosis occurred in five patients receiving more than 2 gm of methotrexate. Hepatic fibrosis and portal inflammation, which were also noted in the methotrexate-treated patients, appeared to be dose related, but not the fatty infiltration and focal necrosis that occurred in both treated and untreated patients. Some fibrosis was also seen in non-methotrexate-treated psoriatics. Liver function tests were poor indicators of hepatic pathologic conditions demonstrated on liver biopsy. Long-term methotrexate therapy is hepatotoxic in some individuals and should not be used when other modes of therapy are adequate.