Methotrexate without liver biopsy?

One of the unpleasant features of taking methotrexate for psoriasis is the need for periodic liver biopsies. Methotrexate (MTX) can damage the liver in ways that can be missed by blood tests; a biopsy can detect this damage before it reaches a crisis point. (The fact that physicians do not seem to agree on how frequently patients should receive biopsies is a topic for another day.)

But new tests are emerging that may, before long, greatly reduce the role for invasive (and potentially dangeous) biopies. In a recent clinical trial, a pair of noninvasive, ultrasound-style tests, the Fibroscan and the Fibrotest, were shown to be accurate in most cases:

Fibrotest accurately predicted the presence of significant liver fibrosis while the Fibroscan accurately predicted the absence of significant liver fibrosis in MTX users [each in more than 80% of cases].

Methotrexate (read more on methotrexate here) is like the Timex of psoriasis treatments--this inexpensive cancer drug has been around since the Korean War and is still used widely for psoriasis and psoriatic arthritis, despite its potentially serious risks. If noninvasive alternatives to liver biopsies are perfected, methotrexate as an option may keep on ticking.