Mtx/Anti TNF combo therapy and the liver

[crohnsinct]

I came across this because my daughter has psoriasis and apparently, the incidence of liver damage with mtx use is higher in the psoriatic population. This is further complicated by the fact that it usually will not show in blood tests. Therefore, there are various recommendations as to when to get a liver biopsy. Liver biopsy is one of the things O's GI wants to discuss in March. In large part because of her psoriasis but also given her grandmother's autoimmune hepatitis.

For those on combo Anti TNF/Mtx therapy though there is an encouraging note in this article.

http://www.jwatch.org/jd200706150000001/2007/06/15/are-liver-biopsies-necessary-psoriasis-patients

 

[my little penguin]

Everything I have seen is it's less of an issue for kids
More an issue for adults
But docs don't know why there is a difference

 

[Maya142]

I asked M's GI about that (she had psoriasis as a 4 year old, and I had read a similar study!) and she said she wouldn't recommend a biopsy. However, we have no autoimmune hepatitis in the family.
M is no longer on MTX but has been up to 25mg (1mL) with Remicade/Humira and had no issues with bloodwork or anything that indicated liver issues.

 

[crohnsinct]

Yeah. The jury is still out on how often to do biopsies. It used to be they did a pre treatment biopsy and then at every cumulative 1 gram. They stopped the pre treatment biopsies except for high risk (diabetes, obese, alcohol use).

O's bloods are fine also but the GI says psoriasis masks the damage in the blood so that is why at some point they have to do the biopsy. I have been reading lately that some docs are saying you can wait for up to 3-4g cumulative with psoriasis patients.

O is just at over 1g but she is going in for scopes and I wonder if GI and derm think she needs biopsy soon if they will just do one at the same time as scopes? Probably not...that would be to convenient for me.

Oh yeah and in addition to her grandmother her father has fatty liver...between the bad livers in the family and the mtx use I hope the no alcohol use speeches have sunk in:shifty:

 

[Clash]

Fairly certain my"no alcohol" speeches may fall on deaf ears! 18 is that age where pretty much everything falls on deaf ears! His blood work has always been normal and honestly I think I may have to go with lalalalalalala on this one because my stress levels are already reaching "no amount of wine will help" levels. That and CICs 1g cumulative info is way over my head and reads like banana banana banana to me. LOL!

I'm not going to Google...I'm not going to Google...I'm not going to Google

 

[crohnsinct]

You are cracking me up Clash!

I think you are fine. If his bloods are good nothing to worry about. It's just stupid psoriasis that masks the blood results. Plus did you read the statement that anti TNF actually helps protect the liver from the mtx! Bring on the Humira! But I will sing that song right along with you...lalalalalalala! Also going out to buy more wine!

 

[Maya142]

My "no alcohol" speeches also fall on deaf ears and generally result in me drinking alcohol!
S is on Humira and MTX and in college and I know she drinks:ybatty:. Blood work is always perfect, thankfully.

 

[Tesscorm]

S is not on MTX but I did try the no alcohol speech... with limited success. I think it's worth having the conversation and I've certainly stressed the impact alcohol can have on his system and that it certainly can't be a good combination with remicade but, at these ages, the best we can hope for is their acknowledgement of their situation and moderation. :ack:

Didn't help that BOTH his GIs (ped and adult) told him some alcohol would be fine - but that he had monitor how he felt after drinking alcohol. Yep, I bet he's in fine shape to monitor AFTER the drinks begin! :lol:

I hate when this happens but sometimes we all (because we were once their ages too) need to learn from mistakes. S still suffers from his injured shoulder, which began when he dislocated it... in Dominican Republic, on a grad trip, on his birthday, slipping in the shower at 3am! Hmmmm.... :beerchug:???? I hate that his shoulder still causes him pain fairly regularly but we all know we can't protect them all the time.

 

[my little penguin]

Fingers in my ears ( lalala)
DS is only 11.

 

[Jmrogers4]

Constantly have the no drinking talk, I have even gone so far as to when he was throwing his guts up after the barrium drink for MRE to say "this is what it's like after you drink, no fun huh? Why would you want to feel that way?"

 

[nogutsnoglory]

As an adult my conbo therapy with MTX resulted in high love enzymes but when I stopped MTX they went back to normal. I think it's different for all and just needs to be monitored.

 

[crohnsinct]

High love enzymes That's all we need with the alcohol:yfaint: Maybe time to circle back to the mtx birth control talk again:hallo3:

no guts: JK I am sure that was a typo....and you meant liver:ylol:

jm: awesome move! Wish I thought of that!

 

[Mehita]

Must admit I pull the gluten card out with DS about alcohol. It was a bit of a bummer when gluten free beers started coming out.

Might need to borrow Jmrogers example!

 

[Maya142]

:lol: Mehita my older daughter has a roommate this year who has celiac and is, of course, gluten free. She came home winter break and proudly started listing all the gluten free alcohols she'd learned (tequila, certain kinds of vodka etc.). Not really what I was hoping she would learn at college :ybatty:!

 

[crohnsinct]

Had O's follow up today and I know the biopsy was mentioned here and maybe somewhere else but can't remember.

Her doc is pretty conservative as far as procedures go. Friday, she is having her first scope since dx three years ago. So he would like to wait a while for the liver biopsy. He wouldn't do them both at the same time anyway so there goes that idea.

He and Derm agree that psoriasis mass the damage in bloods but both feel the anti tnf does help a bit.

She is just over 1kg cumulative and he feels we can push it another 500 to 1000mg's. So maybe in another year.

I hope he's right.