ความชุกและภาวะเสี่ยงในการเกิดภาวะ methotrexate-induced liver injury             ของคนไข้สะเก็ดเงินในโรงพยาบาลพหลพลพยุหเสนา จังหวัดกาญจนบุรี

Saranya Srivarasat

Authors

Saranya Srivarasat Department of internal medicine, Phaholpolpayuhasena Hospital, Kanchanaburi Province 71000

Keywords:

prevalence, risk factor, liver injury, methotrexate, psoriasis

Abstract

Objectives: To determine the prevalence of MTX-DILI and identify associated risk factors among psoriasis patients receiving MTX at Phaholpolpayuhasena Hospital, Kanchanaburi, Thailand.

Methods: This retrospective observational study reviewed medical records of psoriasis patients treated with MTX between October 2023 and September 2024. A total of 165 patients were identified, of whom 115 met the calculated sample size. The collected data included demographics, clinical characteristics, cumulative MTX dose, folic acid supplementation, comorbidities, health behaviors (alcohol and smoking), and liver function tests (ALT, AST, ALP, bilirubin). Descriptive statistics were used to summarize baseline characteristics and to estimate the prevalence of MTX-DILI. Multivariate analysis was performed to evaluate associations between potential risk factors and MTX-DILI.

Results: Among 115 patients, the prevalence of MTX-DILI was 5.22% (6 patients with ALT or AST > 120 U/L). The misdiagnosis rate was 10.43%. Cumulative dose was significantly associated with MTX-DILI. Compared with patients receiving a low cumulative dose (≤1.5 g), those in the high-dose group (≥3.5 g) had a significantly increased risk (adjusted OR = 6.21, 95% CI 1.01–38.2; p=0.048). Alcohol consumption was not significantly associated with MTX-DILI (p=0.107). Folic acid supplementation was also not significantly associated with MTX-DILI; however, patterns of folic acid prescription differed significantly between clinics (p < 0.001).

Conclusions: The observed prevalence of MTX-DILI aligns with previously reported rates (2–8%), A clear association between cumulative methotrexate dose and the risk of liver injury was observed, highlighting the importance of risk assessment and regular monitoring of liver function in all patients, both before treatment initiation and during follow-up by dermatology specialists.

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