P316. Assessment of liver fibrosis by transient elastography in patients with inflammatory bowel disease undergoing treatment with methotrexate
A. Araujo Míguez1, A. Giráldez Gallego1, E. Leo Carnerero1, C. Trigo Salado1, M.D. De la Cruz Ramírez1, J.M. Herrera Justiniano1, J.L. Márquez Galán1
1Hospital Universitario Virgen Del Rocío, Digestive Diseases, Sevilla, Spain
Background: Transient elastography (TE-Fibroscan) is a non-invasive method designed to estimate liver fibrosis (LF), by measurement of liver stiffness (LS), and may be useful for monitoring LF methotrexate (MTX)-induced. Our objective was to determine whether LS values measured by TE differ among inflammatory bowel disease (IBD) patients treated with MTX and those who have never received. Our secondary objective was to analyze whether these values increase proportionally with the accumulated dose (AD) of MTX.
Methods: Prospective study of consecutive IBD patients: (a) study group, 30 patients (29 Crohn's Disease [CD], 1 Ulcerative Colitis [UC]) undergoing MTX treatment with 34 TE measurements, and; (b) 23 control patients (22 CD and 1 UC).
We analyzed: (1) baseline characteristics: age, gender, alcohol and tobacco consumption, phenotypic IBD data, CARD15 mutations and IBD treatment, and; (2) factors that could have an impact on TE results: diabetes, body mass index (BMI), hepatitis B and C, echo-steatosis and dyslipidemia. In the study group we determined MTX administration route, treatment time and AD at the time of TE.
Statistical assessments: Student's t‑test for quantitative and Chi-square test for qualitative variables, and Pearson's test to determine the correlation between the AD of MTX and LS.
Results: Both groups had similar baseline characteristics; but the use of biological agents was higher in the study group (53 vs 26%, p 0.04). No significant differences in dyslipidemia (30% control group vs 15%, p 0.1), echo-steatosis and BMI. Paradoxically, LS value was higher in the control group (5.5 kPa ±2.3 [range 2.8–14.3] vs 4.5±1.0 [2.8–7.3]; p 0.03). Multivariate analysis showed that the only factor that influences LS elevation is dyslipidemia. In study group, mean treatment time with MTX was 93.3 weeks (range 6–248) and AD 1442.7 mg (150–3425). Administration route was parenteral in 23 cases, oral in 4 and both in 7. No differences between AD and LS was found (r 0.036; p 0.8).
Conclusions: LS in IBD patients who have undergone MTX treatment is not elevated compared to MTX-naive patients. In our serie, paradoxical increase in control group would be secundary to other factors. AD is not related to LS; in this sense, MTX seems to be a safe treatment. Nevertheless, it is necessary to evaluate if the individual monitoring of LS can detect changes that suggest significant LF. In opposite caso, traditional recommendations for monitoring LF in patients receiving MTX may need to be reviewed.