Methotrexate use does not increase the prevalence of hepatic steatosis: a real-world retrospective nested case-control s
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ORIGINAL ARTICLE
Methotrexate use does not increase the prevalence of hepatic steatosis: a real-world retrospective nested case-control study Yunjung Choi 1,2 & Chang Hun Lee 2,3 & In Hee Kim 2,3 & Eun Hae Park 2,4 & SoJeong Park 5 & Wan-Hee Yoo 1,2 Received: 17 August 2020 / Revised: 5 October 2020 / Accepted: 7 October 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective We aimed to determine whether methotrexate (MTX) treatment in patients with rheumatoid arthritis (RA) leads to the development of non-alcoholic fatty liver (NAFL). Method Data were derived from records of all patients with RA who underwent abdominal ultrasonography at the Jeonbuk National University Hospital. Patients with ultrasound-proven NAFL were identified, and those without NAFL were matched by age and sex using the propensity score matching method at 1:3 ratio. We also analyzed the Health Insurance Review and Assessment Service-National Patient Samples, a nationwide cohort database, to determine the association between MTX use and NAFL in a large number of patients (n = 24,653). Results In the hospital cohort, 92 patients with NAFL did not show significant differences in the cumulative MTX dose when compared with the no-NAFL group (n = 276) (1908.5 ± 1757.5 vs. 1948.6 ± 2118.8 mg, p = 0.911). The prevalence of NAFL was not significantly different across strata of cumulative MTX dose. Multiple logistic analyses identified hypertriglyceridemia (OR, 4.88 [95% CI, 1.13–20.93]) and higher body mass index (OR, 1.22 [95% CI, 1.05–1.41]) as being associated with an increased risk of NAFL. In the nationwide cohort, the MTX exposure rate between the NAFL and no-NAFL groups was not significantly different. Conclusions Collectively, no significant association between NAFL development and administration of MTX was detected in this study. Our results suggest that it is more efficient to adjust for individualized risk factors for NAFL prevention rather than discontinuation of MTX in patients with RA. Key Points • NAFLD has been highlighted with increasing prevalence worldwide and possible progression to end-stage liver disease. • Cumulative dose or exposure history of MTX does not show a significant association with NAFLD prevalence. • Modifying well-established risk factors is more efficient in NAFLD prevention rather than discontinuation of MTX.
Keywords Liver steatosis . Methotrexate . Non-alcohol fatty liver . Rheumatoid arthritis
Yunjung Choi and Chang Hun Lee contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05456-y) contains supplementary material, which is available to authorized users. * Wan-Hee Yoo [email protected] 1
Division of Rheumatology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, South Korea
2
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
3
Division of Gas
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