Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review
Background: Methotrexate is well-known in treating inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriasis (Ps), and psoriatic arthritis (PsA). Several reports have indicated a higher incidence of methotrexate (MTX)-related liver adverse events in patients with IBD. We aim to investig...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:9486f1ec91af447f95470a58707d9df12021-11-22T05:57:47ZPatients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review2296-858X10.3389/fmed.2021.774824https://doaj.org/article/9486f1ec91af447f95470a58707d9df12021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.774824/fullhttps://doaj.org/toc/2296-858XBackground: Methotrexate is well-known in treating inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriasis (Ps), and psoriatic arthritis (PsA). Several reports have indicated a higher incidence of methotrexate (MTX)-related liver adverse events in patients with IBD. We aim to investigate the risk of liver injury in patients with IBD and those with non-IBD diseases treated with MTX.Methods: We searched PubMed, Embase, and the Cochrane Library for articles that reported liver adverse events in patients with IBD, RA, and Ps/PsA, receiving MTX therapy. Additional articles were obtained by screening the references of recent meta-analysis and reviews. Raw data from included articles were pooled to calculate the cumulative incidence of total liver injury (TLI), MTX discontinuation (MTX-D), and liver fibrosis (LF). RR (relative risk) was calculated to compare the difference between patients with IBD and those with non-IBD diseases.Results: A total of 326 articles with 128,876 patients were included. The patients with IBD had higher incidence of TLI [11.2 vs. 9.2%; relative risk (RR) = 1.22; P = 0.224] and MTX-D (2.6 vs. 1.8%; RR, 1.48; P = 0.089) than patients with non-IBD diseases. Due to the publication bias, trim-and-fill was performed. Afterwards, the patients with IBD showed significantly higher risk of TLI (11.2 vs. 3%; RR = 3.76; p < 0.001), MTX-D (3.3 vs. 0.7%; RR = 5; p < 0.001) and LF (3.1 vs. 0.1%; RR = 38.62; P = 0.001) compared with patients with non-IBD diseases.Conclusion: IBD is associated with a higher risk of MTX-related liver injury. The mechanism of MTX-induced hepatotoxicity might be different in IBD and non-IBD diseases, and needs to be verified in future research.Yang WangYang WangYimin LiYun LiuYun LiuYifan ZhangYifan ZhangZiliang KeZiliang KeYu ZhangYu ZhangYulan LiuYulan LiuFrontiers Media S.A.articleinflammatory bowel diseasemethotrexateliver injuryhepatotoxicitymeta-analysisMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
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EN |
| topic |
inflammatory bowel disease methotrexate liver injury hepatotoxicity meta-analysis Medicine (General) R5-920 |
| spellingShingle |
inflammatory bowel disease methotrexate liver injury hepatotoxicity meta-analysis Medicine (General) R5-920 Yang Wang Yang Wang Yimin Li Yun Liu Yun Liu Yifan Zhang Yifan Zhang Ziliang Ke Ziliang Ke Yu Zhang Yu Zhang Yulan Liu Yulan Liu Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| description |
Background: Methotrexate is well-known in treating inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriasis (Ps), and psoriatic arthritis (PsA). Several reports have indicated a higher incidence of methotrexate (MTX)-related liver adverse events in patients with IBD. We aim to investigate the risk of liver injury in patients with IBD and those with non-IBD diseases treated with MTX.Methods: We searched PubMed, Embase, and the Cochrane Library for articles that reported liver adverse events in patients with IBD, RA, and Ps/PsA, receiving MTX therapy. Additional articles were obtained by screening the references of recent meta-analysis and reviews. Raw data from included articles were pooled to calculate the cumulative incidence of total liver injury (TLI), MTX discontinuation (MTX-D), and liver fibrosis (LF). RR (relative risk) was calculated to compare the difference between patients with IBD and those with non-IBD diseases.Results: A total of 326 articles with 128,876 patients were included. The patients with IBD had higher incidence of TLI [11.2 vs. 9.2%; relative risk (RR) = 1.22; P = 0.224] and MTX-D (2.6 vs. 1.8%; RR, 1.48; P = 0.089) than patients with non-IBD diseases. Due to the publication bias, trim-and-fill was performed. Afterwards, the patients with IBD showed significantly higher risk of TLI (11.2 vs. 3%; RR = 3.76; p < 0.001), MTX-D (3.3 vs. 0.7%; RR = 5; p < 0.001) and LF (3.1 vs. 0.1%; RR = 38.62; P = 0.001) compared with patients with non-IBD diseases.Conclusion: IBD is associated with a higher risk of MTX-related liver injury. The mechanism of MTX-induced hepatotoxicity might be different in IBD and non-IBD diseases, and needs to be verified in future research. |
| format |
article |
| author |
Yang Wang Yang Wang Yimin Li Yun Liu Yun Liu Yifan Zhang Yifan Zhang Ziliang Ke Ziliang Ke Yu Zhang Yu Zhang Yulan Liu Yulan Liu |
| author_facet |
Yang Wang Yang Wang Yimin Li Yun Liu Yun Liu Yifan Zhang Yifan Zhang Ziliang Ke Ziliang Ke Yu Zhang Yu Zhang Yulan Liu Yulan Liu |
| author_sort |
Yang Wang |
| title |
Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| title_short |
Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| title_full |
Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| title_fullStr |
Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| title_full_unstemmed |
Patients With IBD Receiving Methotrexate Are at Higher Risk of Liver Injury Compared With Patients With Non-IBD Diseases: A Meta-Analysis and Systematic Review |
| title_sort |
patients with ibd receiving methotrexate are at higher risk of liver injury compared with patients with non-ibd diseases: a meta-analysis and systematic review |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/9486f1ec91af447f95470a58707d9df1 |
| work_keys_str_mv |
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| _version_ |
1718418115991175168 |