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High Liver Enzymes Are Rarely a Reason to Stop Methotrexate in IBD Patients

Am J Gastroenterol 2010, news

Liver enzyme elevations are common with methotrexate therapy for inflammatory bowel disease, but the enzymes usually normalize while therapy continues, Canadian researchers reported online February 16th in the American Journal of Gastroenterology.

"Rarely does methotrexate need to be discontinued because of liver enzyme test abnormalities that either are moderately abnormal or that don't return to normal," senior author Dr. Charles N. Bernstein told Reuters Health by email.

Dr. Bernstein and colleagues at the University of Manitoba in Winnipeg reviewed data on 67 patients with Crohn's disease, 17 with ulcerative colitis and 3 with indeterminate colitis.

The patients had been taking methotrexate for a mean of 81 weeks, at a cumulative average dose of 1813 mg. In all, 37 received a cumulative dose of more than 1500 mg.

Sixty-seven patients had normal liver enzyme tests at baseline. Sixteen of these patients developed abnormalities during treatment, including 7 with underlying risk factors for liver disease (e.g., hepatotoxic drugs, obesity, alcohol consumption). In all but 2, enzyme levels normalized with no dose reduction.

In the 20 patients with high enzymes at baseline, all of the elevations were mild, and no one had coagulation or bilirubin abnormalities. Test results actually normalized during methotrexate therapy in 9 and remained stable in 2, but they worsened in another 9.

Eleven of the patients who received cumulative methotrexate doses exceeding 1500 mg had a total of 17 liver biopsies. Fifteen biopsies showed grade 1 fibrosis; none showed moderate or severe fibrosis (grade 3b or 4).

"It seems that liver biopsies are rarely helpful and are likely not needed routinely, but may be indicated in selected patients with liver enzyme tests that do not normalize," Dr. Bernstein said.

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Thanks David, this is good to know, I don't drink so I don't worry too much. BTW are you a researcher?? You do alot of info.. just curious. ;)
Jettalady said:
Thanks David, this is good to know, I don't drink so I don't worry too much. BTW are you a researcher?? You do alot of info.. just curious. ;)
I did work in pharma R&D for a number of years providing patent information support, my research on this is for my own condition. Which is the ultimate motivator! Glad people are finding it useful.