Is pre-treatment liver biopsy necessary for all hepatitis C genotypes?
Journal Title: Annals of Hepatology - Year 2011, Vol 10, Issue 3
Abstract
Background. Current practice guidelines recommend liver biopsy prior to treatment of hepatitis C genotype-1 but not for genotype-2/3; this is based on expert opinion, not on published evidence. Methods. In retrospective analysis of a large trial database prior to the publication of recent guidelines, we compared outcomes in 985 treatment-naïve patients with hepatitis C who did or did not undergo liver biopsy before starting peginterferon alfa-2a plus ribavirin. Results. Physicians elected to treat 141/654 (21.6%) genotype-1 patients and 126/331 (38.1%) genotype-2/3 patients without liver biopsy. There were no differences in baseline characteristics among those with or without pre-treatment liver biopsy, except for female preponderance in genotype-1 patients with liver biopsy. The sustained viral response (SVR) rate was no different amongst genotype-2/3 patients who had a biopsy before treatment with 66.3% SVR vs. 69.8% of those treated without biopsy (p = 0.546), but significantly higher among genotype-1 patients with pre-treatment liver biopsy at 54.6 vs. 44.0% for those treated without a liver biopsy (p = 0.029). In genotype-1 patients with liver biopsy, more patients with cirrhosis had dose adjustments (p = 0.0057) rather than drug discontinuation. There was tendency for earlier discontinuation among patients without pre-treatment liver biopsy. Conclusions. Pre-treatment liver biopsy was associated with better SVR amongst genotype-1 patients. This improvement may reflect ongoing commitment to completing the treatment course by both patient and physician. In genotype-2/3 patients, pre-treatment liver biopsy may not be essential to maximize SVR rates. This study validates the recommendations of the most recent treatment guidelines for hepatitis C.
Authors and Affiliations
Kevork M. Peltekian, Vincent G. Bain, Samuel S. Lee, Morris Sherman, Curtis L. Cooper, Eric M. Yoshida, Paul J. Marotta, Mel Krajden, Robert Balshaw, Marc Deschênes
Keywords
Related Articles
- EP ID EP78041
- DOI -
- Views 158
- Downloads 0
Liver transplantation utilizing a severely fractured graft: every organ counts
In our current era where shortage of liver grafts is commonplace, utilization of traumatic liver grafts may represent an opportunity to expand the organ donor pool without compromising graft survival. However, data on li...
Hepatic dysfunction in children with tuberculosis on treatment with antituberculous therapy
Aim. To determine the incidence and factors associated with drug induced hepatic dysfunction in children on anti-tuberculous treatment (ATT). Setting. Pediatric Tuberculosis Clinic at B.J. Wadia Children’s...
Tenofovir as a first line option for prophylaxis in a patient with hepatitis B virus associated nephrotic syndrome
Plasminogen activator inhibitor type 1 serum levels and 4G/5G gene polymorphism in morbidly obese Hispanic patients with non-alcoholic fatty liver disease
Background. The plasminogen activator inhibitor type-1 (PAI-1) has been implicated in the regulation of fibrinolysis and extracellular matrix components. The single base pair guanine insertion/deletion polymorphism (4G/5...
Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis
Background. Carvedilol appears to be more effective than propranolol in the treatment of portal hypertension in cirrhotic patients. Aim. To compare the effects of carvedilol vs. propranolol on systemic and splanchnic hae...