Transient Elastography for Detecting Liver Fibrosis in Methotrexate-Treated Patients with Inflammatory Disorders: A Systematic Review

Objective: Methotrexate (MTX) is used for the treatment of inflammatory disorders but can cause liver enzyme abnormalities. Liver enzyme elevations are neither specific nor sensitive for detecting liver fibrosis. Liver biopsy is an imperfect gold standard with its own limitations. Fibroscan is a non-invasive technique used to evaluate liver fibrosis. The objective of this study was to review the literature to characterize the utility of Fibroscan for detection of liver fibrosis compared to biopsy in patients with inflammatory conditions treated with MTX. Methods: A systematic literature search was carried out of all English publications. The search was limited to studies involving subjects greater than 18 years of age, meeting criteria for the diagnosis of Crohn's Disease (CD), Rheumatoid Arthritis (RA), psoriasis (Ps) or psoriatic arthritis (PsA).Studies where liver biopsy was not performed were excluded. Results: Among 18 references identified, three publications met the criteria. The selected studies were prospective, cross-sectional studies (n=21-518).The cutoffs for significant or severe fibrosis based on Fibroscan score (FSS) differed amongst the studies (7kPA-8.7kPa).FSS did not reflect biopsy findings in a large portion of patients (40%-69%).The accuracy of Fibroscan for the detection of no or mild fibrosis (F<2) ranged from 0%-88%.The accuracy of Fibroscan for the detection of significant fibrosis or cirrhosis (F2-4) ranged from 0%-30%. Conclusions: There is insufficient evidence to support the use of Fibroscan for detecting liver fibrosis in a MTX-taking population with inflammatory disorders