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Ann Hepatol ; 10(3): 260-9, 2011.
Article in English | MEDLINE | ID: mdl-21677327

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.


Subject(s)
Hepacivirus/genetics , Hepatitis C/genetics , Hepatitis C/pathology , Liver/pathology , Practice Guidelines as Topic , Adult , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Biopsy , Dose-Response Relationship, Drug , Female , Genotype , Hepacivirus/drug effects , Hepatitis C/drug therapy , Humans , Interferon alpha-2 , Interferon-alpha/pharmacology , Interferon-alpha/therapeutic use , Liver/virology , Male , Middle Aged , Polyethylene Glycols/pharmacology , Polyethylene Glycols/therapeutic use , Recombinant Proteins , Retrospective Studies , Ribavirin/pharmacology , Ribavirin/therapeutic use , Treatment Outcome
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