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.
| Original language | English |
|---|---|
| Pages (from-to) | 260-269 |
| Number of pages | 10 |
| Journal | Annals of Hepatology |
| Volume | 10 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2011 |
Bibliographical note
Funding Information:As the guarantor of the article Dr. Peltekian accepts full responsibility for the conduct of analysis, had full access to the data and made the final decision to publish the article. The first draft of the Methods and Results and the tables were prepared by Blair J. Jarvis MSc under the direction of Dr. Pelte-kian using study reports generated by Syreon Corporation. Dr Peltekian prepared the first drafts of the Introduction, Discussion and the abstract. Mr. Jarvis did this work under contract to Roche Canada. Drs Peltekian, Bain, Lee, Sherman, Cooper, Yoshida, Marotta, Krajden, and Deschênes were involved in the planning and conduct of the study, collection and interpretation of data and revising the manuscript. Dr. Balshaw was involved in the design and conduct of the statistical analyses and drafting of the manuscript. All authors read and approved the final draft submitted to the journal. This study was funded by Roche, Mississauga, Canada.
ASJC Scopus Subject Areas
- Hepatology
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Validation Study
