When should a liver biopsy be performed on patients receiving MTX?
Routine baseline or periodic liver biopsies in patients receiving MTX are not recommended. Usually when liver tests are persistently or significantly elevated in patients on MTX, the dose is reduced and reevaluation is performed. If the liver function tests continue to be significantly elevated, MTX is usually stopped and therapy is switched. With the multitude of non-bDMARD and bDMARD therapies available, the underlying inflammatory disorder can usually be controlled with another nonhepatotoxic medication.