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INTRODUCTION Methotrexate (MTX) is a synthetic antimetabolite with many therapeutic indications, mainly anti-inflammatory and immunosuppressant at relatively low doses and antineoplastic at high doses.[ , ] MTX competitively inhibits dihydrofolate reductase, so decreasing tetrahydrofolate level leads to blocks the synthesis of purines, pyrimidines, DNA, ribonucleic acid, thymidylate, and proteins.[ , , ] It is well known that MTX is a hepatotoxic drug, and this leads to limitation of its clinical use

In the SURMOUNT trials for weight management, participants achieved substantial weight loss, with some individuals losing 1520% of their body weight over the study period, which may indirectly benefit liver health

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