S1486 Impact of Obesity on Liver Fibrosis and Steatosis in Patients Diagnosed With Methotrexate-Associated Liver Injury: A Retrospective Study

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Introduction: Methotrexate (MTX) is commonly used to treat different rheumatologic, dermatologic and oncologic diseases. The correlation between obesity, a known risk factor for nonalcoholic fatty liver disease (NAFLD), and MTX-associated liver toxicity remains unclear. The aim of this study is to investigate the impact of obesity as a risk factor for increased liver fibrosis and steatosis in patients treated with MTX. Methods: We retrospectively reviewed the charts of patients seen at our hepatology clinic between January 2016 and 2021 for MTX-induced liver injury. Data regarding baseline characteristics, body mass index (BMI) and elastography results including liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were collected. The cutoff used for LSM and CAP were 13 kPa and 250 dB/m, respectively. Results: Thirty-five patients with a mean age of 58 years (range 32-74), including 23 females (66%) were included. Median BMI was 32.1 kg/m2 (range 20.5-51.8). Median LSM by elastography was 10.8 kPa and median CAP was 284.7 dB/m. Seven patients diagnosed with MTX- induced liver injury with a CAP ≤ 250 were identified, all of them were non-obese (BMI< 30). 28 (80%) patients had a CAP >250 including 21 (75%) with a BMI ≥30 and 7 (25%) with a BMI < 30 (P < 0.001). 20 (57.1%) individuals had a LSM of ≤13, of those, 11 (55%) were non-obese and 9 (45%) were obese. For a LSM above 13, 12 (80%) were obese (P < 0.05). Conclusion: A positive association exists between obesity and MTX-associated liver injury. Liver fibrosis and steatosis in patients treated with MTX can be a result of underlying obesity/NAFLD, direct effect of MTX or both. Prospective studies are needed to better understand the underlying association (Table 1). Table 1. - The association between CAP and LSM with BMI in patients with MTX-induced liver injury BMI (kg/m2) Total (N = 35) P-value < 30 ≥30 CAP (dB/m) < 0.001 ≤250 7 (100%) 0 (0%) 7 (20%) >250 7 (25%) 21 (75%) 28 (80%) LSM (kpa) 0.016 ≤13 11 (55%) 9 (45%) 20 (57.1%) >13 3 (20%) 12 (80%) 15 (42.9) BMI: Body mass index, LSM: liver stiffness measurement, CAP: controlled attenuation parameter.

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