A chemotherapy drug that can cause liver damage has been used to slow and even reverse the progression of primary biliary cirrhosis (PBC). An eventual result of the finding could be less demand for liver transplants.
Marshall Kaplan, MD, and colleagues at New England Medical Center have reported in two separate articles the successful use of methotrexate to treat PBC. In one article (Semin Liver Dis 1997;17:129-136), Dr. Kaplan reported that some patients appeared to have sustained remission while taking methotrexate. He concluded that the most effective treatment for PBC "will most likely use a combination of drugs such as ursodeoxycholic acid, colchicine, and methotrexate."
Another study (Ann Intern Med 1997;126:682-688) reached similar conclusions. Dr. Kaplan, Chief of the Division of Gastroenterology, found that each of five patients who received methotrexate experienced a remission of symptoms and showed few signs of PBC 5 to 12 years following treatment.
Should this treatment for PBC continue to be successful, fewer patients may require liver transplantation. Currently, about 7% of liver transplants are performed in patients with PBC. An irony of the finding is that methotrexate is contraindicated in patients with liver disease. The 1997 Physicians' Desk Reference reports that methotrexate has the potential for acute and chronic hepatotoxicity and that "caution is indicated in the presence of preexisting liver damage or impaired hepatic function."
For Your Information:
Marshall Kaplan, MD
Chief, Division of Gastroenterology, New England Medical Center
750 Washington Street, Boston, MA 02111
617-636-5877 (phone)
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