title: Is pre-treatment liver biopsy necessary for all hepatitis C genotypes?
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.affiliation: Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada. Kevork.Peltekian@dal.ca
authors.forename: Kevork M
authors.initials: KM
authors.lastname: Peltekian
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bain
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lee
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cooper
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Marotta
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
authors.forename: Robert
authors.initials: R
authors.lastname: Balshaw
authors.forename: Marc
authors.initials: M
authors.lastname: Deschênes
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics*; D006526:Hepatitis C / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use; D008099:Liver / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a