Bichenapally Sumahitha, Khachatryan Vahe, Muazzam Asmaa, Hamal Chandani, Velugoti Lakshmi Sai Deepak Reddy, Tabowei Godfrey, Gaddipati Greeshma N, Mukhtar Maria, Alzubaidee Mohammed J, Dwarampudi Raga Sruthi, Mathew Sheena, Khan Safeera
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Pathology Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2022 Oct 31;14(10):e30910. doi: 10.7759/cureus.30910. eCollection 2022 Oct.
Methotrexate (MTX), an antifolate agent, is recommended as the first-line disease-modifying antirheumatic drug (DMARD). In this systematic review, our goals were to assess liver fibrosis in methotrexate-treated patients, evaluate liver fibrosis in relation to treatment duration and cumulative dose, and identify differences based on the underlying disease. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform the systematic review. We thoroughly searched PubMed, PubMed Central (PMC), and Cochrane library databases to identify relevant articles based on predefined selection criteria. Studies were selected based on the following predefined eligibility criteria: English language, papers from the last 20 years, systematic reviews, observational studies, randomized controlled trials (RCTs), and clinical trials, which included papers on MTX playing roles in the development of liver fibrosis with the derived data transferred to a template. Following that, quality was assessed using the appropriate assessment tool for each study. The initial search yielded 512 results. Following a thorough review, 10 studies were chosen for final consideration: eight observational studies and two systematic reviews. Liver enzyme (LE) elevations during MTX therapy are a common but transient problem. Serial abnormal LE tests may be associated with liver pathology, but fibrosis development is uncommon. However, it is unclear from the literature how therapy should be adjusted in the case of elevated LE and to what extent MTX is linked to liver toxicity; definitive conclusions cannot be drawn because more research is needed.
甲氨蝶呤（MTX）是一种抗叶酸药物，被推荐作为一线改善病情抗风湿药（DMARD）。在本系统评价中，我们的目标是评估接受甲氨蝶呤治疗患者的肝纤维化情况，评估肝纤维化与治疗持续时间和累积剂量的关系，并确定基于基础疾病的差异。我们遵循系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。我们全面检索了PubMed、PubMed Central（PMC）和Cochrane图书馆数据库，以根据预定义的选择标准识别相关文章。根据以下预定义的纳入标准选择研究：英文文献、过去20年的论文、系统评价、观察性研究、随机对照试验（RCT）和临床试验，其中包括关于甲氨蝶呤在肝纤维化发生中作用的论文，并将所得数据转移到模板中。随后，使用适用于每项研究的评估工具评估质量。初步检索产生了512条结果。经过全面审查，选择了10项研究进行最终审议：8项观察性研究和2项系统评价。甲氨蝶呤治疗期间肝酶（LE）升高是一个常见但短暂的问题。连续异常的LE检测可能与肝脏病理相关，但纤维化发展并不常见。然而，从文献中尚不清楚在LE升高的情况下应如何调整治疗以及甲氨蝶呤与肝毒性的关联程度；由于需要更多研究，无法得出明确结论。
