PIIINP measurements for the detection of liver fibrosis in methotrexate-treated patients with psoriasis

An easy daily practice for monitoring MTX-treated psoriasis patients

Expert opinion

Methotrexate (MTX) has been used to treat psoriasis for over 50 years. It works by suppressing the immune system, slowing down the overproduction of skin cells that cause psoriasis. However, patients taking MTX need to have regular blood tests to ensure that the drug is being processed safely by the body and not negatively affecting the liver, blood, or bone marrow. The main risk of long-term methotrexate use is the potential for liver damage, as MTX can cause hepatic fibrosis.
Pathologists are often faced with the dilemma of whether to recommend continuation of methotrexate therapy for psoriasis within the context of existing pro-fibrogenic risk factors, or in patients diagnosed with liver fibrosis.
Accurate staging of liver fibrosis in chronic liver diseases is crucial for prognostic assessment over the course of the disease. The histological evaluation of a liver biopsy is still the gold standard in assessing the liver fibrosis stage. However, liver biopsy is an invasive procedure that bears the risk of complications. Non-invasive tests were developed to avoid this risk, assessing liver fibrosis based on techniques to measure liver elasticity (FibroScan®) or on combinations of laboratory markers.
The daily usage of non-invasive markers for fibrosis, such as procollagen-3 N-terminal peptide (PIIIP), is intended to lower the amount of potential harmful liver biopsies. PIIIP is the screening method advised in current EU psoriasis guidelines.
From surrogate marker gold standard method? Scientists and clinicians will always find pros and cons when trying to answer this question. Jull van de Reek discloses the outcomes of a study performed on clinical data from MTX-treated psoriasis patients. She offers new arguments and benefits for using PIIIP measurement to assess MTX side-effects in patients treated for psoriasis.
Read more in this article to discover the benefits of using PIIIP as a liver fibrosis marker……and think one step ahead about how you could use this marker to monitor other liver fibrosis diseases, such NASH or NAFLD.


In the past, a varying incidence of liver fibrosis, which was attributed to methotrexate (MTX) treatment for psoriasis, has been reported. However, recent reports show lower incidences of liver fibrosis in this group, and a low or absent risk attributable to MTX. Dawwas et al. found that end-stage liver disease related to MTX was very uncommon (0.07% of 158,904 liver transplant patients), and that features of the metabolic syndrome were prevalent in those affected.


British Journal of Dermatology. 2017 Jan 23. (doi: 10.1111/bjd.15313).

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