P110 Low prevalence of liver fibrosis in patients with atopic dermatitis on methotrexate

Abstract Methotrexate is a widely used systemic agent in dermatology for patients with both atopic dermatitis (AD) and psoriasis. Recent studies have shown no link between liver fibrosis and prolonged methotrexate use in the population with psoriasis. Other risk factors including body mass index (BMI), metabolic syndrome, diabetes and alcohol intake are greater predictors of liver fibrosis. The prevalence of liver fibrosis in patients with AD treated with methotrexate remains unknown. This retrospective, cross-sectional study aimed to determine the prevalence of liver fibrosis in patients with AD receiving methotrexate. It also sought to evaluate the prevalence of potential risk factors for liver fibrosis in this cohort. Adult patients with AD established on methotrexate who attended for liver health assessment between January 2022 and September 2023 were included. Reasons for referral included baseline assessment, abnormal liver function tests or prolonged methotrexate use. All patients underwent transient elastography (FibroScan) to evaluate liver fibrosis. Three values for liver stiffness measurement (LSM) were used to indicate liver fibrosis severity: mild (LSM ≥ 7 kPa), moderate (LSM ≥ 7.9 kPa) and advanced (LSM ≥ 9.5 kPa). In total 114 patients were included in the study. The median age was 51.5 years [interquartile range (IQR) 36.25–63.75] and 44.7% were female. Among the cohort, 30.7% had a BMI ≥ 30 kg m−2. Only 1 of 113 patients had a diagnosis of diabetes mellitus. The median Alcohol Use Disorders Identification Test (AUDIT) score was 4 (IQR 2–6), and 14.2% had an AUDIT score ≥ 8. The median alanine aminotransferase (ALT) level was 21 U L−1 (IQR 18–39). The prevalence rates suggestive of liver fibrosis were 6.1%, 1.8% and 0.9% for LSM thresholds of ≥ 7 kPa, ≥ 7.9 kPa and ≥ 9.5 kPa, respectively. There were significant positive correlations between LSM and BMI (r = 0.23, P = 0.015) and between LSM and waist circumference (r = 0.21, P = 0.029), as determined using Pearson correlation. No association was found between LSM and ALT values or LSM and AUDIT scores. In conclusion, this study demonstrates a low prevalence of liver fibrosis in patients with AD on methotrexate. In contrast, a previous study from this department reported liver fibrosis prevalence rates of 36%, 25% and 17% in patients with psoriasis using LSM thresholds of ≥ 7 kPa, ≥ 7.9 kPa and ≥ 9.5 kPa, respectively. Based on these findings, our department will no longer routinely perform transient elastography assessments for patients with AD on methotrexate with isolated ALT elevations in the absence of other liver fibrosis risk factors. This approach will allow better resource allocation to patients with psoriasis, who are at higher risk of liver fibrosis due to the increased incidence of metabolic syndrome.