Long-term methotrexate therapy has been associated with what hepatic effects?
Long term therapy with frequent but mild elevations in serum liver enzymes. More importantly, methotrexate has been associated with development of fatty liver and hepatic fibrosis and, in rare instances, portal hypertension and symptomatic cirrhosis. Liver tests are typically normal or minimally and transiently elevated. Routine monitoring of patients with regular liver biopsies done at 1 to 2 year intervals or with cumulative methotrexate doses of 1 to 10 grams demonstrates that approximately 30% of patients develop mild-to-moderate histological abnormalities (fat, cellular unrest, mild inflammation, nuclear atypical) and 2 to 20% of patients develop some degree of hepatic fibrosis.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Methotrexate. [Updated 2020 Feb 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548219/
Keywords: Methotrexate, hepatic fibrosis, fatty liver, cirrhosis, portal hypertension