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AAD, NPF guidelines urge liver disease monitoring in psoriasis patients


The latest guidelines for psoriasis from the American Academy of Dermatology and the National Psoriasis Foundation recommend physicians monitor their patients for liver disease when prescribed medication for psoriasis, such as methotrexate.

The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF), is urging physicians to monitor their patients on psoriasis medication for liver disease, citing jointly released guidelines.1

The latest guidelines provide prescribers with information and recommendations regarding the safety and efficacy of prescription medications for psoriasis, including methotrexate, an immunosuppressive agent utilized in therapy for psoriasis. In studies, Methotrexate has been associated with chronic liver injury, cirrhosis, progressive fibrosis and portal hypertension.2

MORE: Psoriasis guidelines offer management pearls for pediatric patients

“Because psoriasis is a risk factor for fibrotic nonalcoholic steatohepatitis (NASH), we look to these guidelines to help improve the detection of liver disease by emphasizing pre-treatment screening,” says Elliot B. Tapper, M.D., assistant professor of Medicine at University of Michigan and guideline contributor. “The challenge is that liver disease is often asymptomatic and as a contraindication for prescribing methotrexate, cost effective and non-invasive approaches are needed to identify the presence of underlying liver disease. The approach outlined in these new guidelines includes serologic tests and liver stiffness assessment by VCTE (Vibration Controlled Transient Elastography), allowing clinicians to identify and monitor patients at risk for liver injury from long term exposure to methotrexate.”

Echosens, a medical technology company specializing in chronic liver disease, suggests physicians monitor their psoriasis patients for liver damage by utilizing non-invasive liver assessment tools, such as their proprietary FibroScan, a VCTE device used to measure fibrosis and steatosis within the liver.3

RELATED: Topical guidelines will provide real-world guidance

“The AAD/NPF guidelines add to the growing evidence that direct assessments of liver health with FibroScan, a rapid, reliable and non-invasive tool, can serve as an essential part of overall health management,” says Jon Gingrich, CEO of Echosens North America. “We are gratified by the growing recognition that liver health assessment with FibroScan can play an important role in the effective and safe management of many chronic conditions, as evidenced by these guidelines for patients with psoriasis undergoing long-term methotrexate use.”

More information on the new guidelines can be found here.


1. Menter, A., Gelfand, J. M., Connor, C., Armstrong, A. W., Cordoro, K. M., Davis, D. M., . . . Elmets, C. A. (2020). Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. Journal of the American Academy of Dermatology, 82(6), 1445-1486. doi:10.1016/j.jaad.2020.02.044

2. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Methotrexate. [Updated 2020 Feb 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548219/

3. Joint American Academy of Dermatology & National Psoriasis Foundation New Care Guidelines for Medication Management of Psoriasis: Echosens Cites Need for Liver Disease Monitoring. (2020, August 12). Retrieved September 25, 2020, from https://www.businesswire.com/news/home/20200812005451/en/Joint-American-Academy-Dermatology-National-Psoriasis-Foundation

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