Methotrexate is used to treat patients with severe psoriasis, but is associated with hepatoxicity. Here, Nicola McDonagh undertakes verification and evaluation of the Siemens ELF Profile test as a marker of the degree of liver fibrosis in such cases.
Methotrexate (MTX) is an immunosuppressant drug used in the management of severe psoriasis. Its use is associated with hepatoxicity, requiring patients to be continuously monitored for the development of liver fibrosis. Currently, the gold standard for the assessment of liver fibrosis is biopsy. However, due to its invasive, distressing nature and expense to the health service, this has brought about the emergence of non-invasive methods of assessment.
Siemens Healthcare has developed the Enhanced Liver Fibrosis (ELF) test for the measurement of liver fibrosis.1 The ELF test combines the measurement of three direct serum biomarkers; amino terminal propeptide of type III procollagen (P3NP), hyaluronic acid (HA) and tissue inhibitor metalloproteinase 1 (TIMP-1). Results are then combined in an algorithm to report a unit-less numeric score, with an increasing score related to fibrosis severity. The ELF assay is a validated biomarker of liver fibrosis in a number of chronic liver diseases; however, it is yet to be validated in patients with liver fibrosis as a result of MTX therapy.
Currently NHS Greater Glasgow & Clyde (GG&C) dermatology patients are monitored for methotrexate-induced liver damage using the single measurement of P3NP. If a patient has two consecutive results >13 µg/L or three results >7 µg/L within a 12-month period, then ultimately biopsy is recommended to determine the extent of liver fibrosis.
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