Methotrexate & liver fibrosis study

[Fred]

This article published in The British Journal of Dermatology assesses whether methotrexate use increases the risk of developing fibrosis.

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Background:
Methotrexate is an effective treatment for psoriasis but concerns regarding the development of liver fibrosis prevent optimal use.

Objectives:
To assess whether methotrexate use increases the risk of developing fibrosis.

Methods:
Searches were performed on MEDLINE, Embase, the Cochrane database and Clinical Trials Register from inception until September 2013 for studies including at least two liver biopsies in people with psoriasis. Double extraction using predefined data fields was performed. RCTs and observational studies were considered. Statistical analysis was performed using Review Manager 5. Quality of observational studies was assessed using a study quality bias checklist.

Results:
Eight observational studies met the inclusion criteria (N=429). The pooled risk difference (RD) of developing significant liver fibrosis was 0.09 (95% CI: -0.03, 0.20). The RD for developing ‘any fibrosis’ was 0.22 (95% CI: 0.04, 0.41). The RD for cirrhosis was 0.04 (95% CI 0.02, 0.07). There was no clear association between cumulative dose of methotrexate and fibrosis. Obesity, diabetes and alcohol use were under reported. The quality of included studies was weak and the degree of selection bias means the results are not generalisable to all patients with psoriasis taking methotrexate.

Conclusions:
High quality, population based studies that consider potential confounders common in the psoriasis population taking methotrexate are justified to better predict the subset of patients at risk of liver fibrosis. In this highly selected population, methotrexate use contributes to the development of ‘any’ fibrosis without clear evidence of risk stratifiers.

Source: NO LINKS ALLOWED

[Caroline]

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The quality of included studies was weak and the degree of selection bias means the results are not generalisable to all patients with psoriasis taking methotrexate.

Doesn't this, in human language, mean that in fact the study is quite worthless?

[Fred]

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The quality of included studies was weak and the degree of selection bias means the results are not generalisable to all patients with psoriasis taking methotrexate.

Doesn't this, in human language, mean that in fact the study is quite worthless?

In some-ways yes, but some would argue any study is worth it. For example if we had a survey on how often you & me agreed, I would say around twice a year. You on the other hand would say never, so that gives an average of once per year which make me right more than you.

[Caroline]

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The quality of included studies was weak and the degree of selection bias means the results are not generalisable to all patients with psoriasis taking methotrexate.

Doesn't this, in human language, mean that in fact the study is quite worthless?

In some-ways yes, but some would argue any study is worth it. For example if we had a survey on how often you & me agreed, I would say around twice a year. You on the other hand would say never, so that gives an average of once per year which make me right more than you.

I don't agree.
Never times anything is always never.