Methotrexate inducing liver damage

The pathological features of methotrexate-induced liver damage have been comprehensively reviewed (52). In patients with psoriasis, baseline liver biopsies were often abnormal, with mild fibrosis, moderate or severe fibrosis, and cirrhosis in 0-30, 0-7, and 0-1.5% respectively. These figures increased after methotrexate use, with fibrosis and cirrhosis in 14—34 and 0-21% respectively. 

Baughman RP, Koehler A, Bejarano PA, et al. Role of hver function tests in detecting methotrexate-induced liver damage in sarcoidosis. Arch Intern Med 2003 163 615-620. 

Collectively, the available data suggest that methotrexate rarely causes significant serious hver damage in patients who have been otherwise carefully selected, who present no risk factors for methotrexate-induced hepatotoxicity, and who have received lower weekly dosages with strict monitoring of liver function (for example transaminases) in order to reduce methotrexate doses when liver enzymes are persistently raised (48). 

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