title: Impact of insulin resistance on sustained response in HCV patients treated with pegylated interferon and ribavirin: a meta-analysis.
abstract: OBJECTIVE
  Recent studies suggested that SVR rates might be lower in HCV patients with insulin resistance (IR) than in patients without IR, but the extent of the impact of IR on treatment response has not been established. We aimed to confirm the role of IR assessed by the homoeostasis model assessment (HOMA-IR) on SVR and to determine its magnitude.
  
  
  METHODS
  We performed meta-analysis of studies evaluating the impact of IR in HCV patients treated with pegylated interferon and ribavirin.
  
  
  RESULTS
  Fourteen studies involving 2732 patients were included. SVR was less frequent in patients with IR than in patients without IR (mean difference: -19.6%, 95% CI: -29.9% to -9.4%, p<0.001). In sensitivity analyses according to HCV-1 patients, patients with IR also less frequently attained a SVR than patients without IR (mean difference: -13.0%, 95% CI: -22.6% to -3.4%, p=0.008). In addition, the baseline HOMA-IR index was lower in responders than in non-responders (mean difference: -0.92, 95% CI: -1.53 to -0.32, p<0.001). In sensitivity analyses restricted to HCV-1 patients, the baseline HOMA-IR index remained lower in responders than in non-responders (mean difference: -0.63, 95% CI: -1.13 to -0.14, p<0.001).
  
  
  CONCLUSIONS
  HCV patients with IR have a 20% lower SVR than patients without IR. The baseline HOMA-IR index is a major determinant of SVR.
authors.affiliation: Service d'Hépato-Gastroentérologie, Hôpital Huriez, CHRU Lille, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.forename: Maud
authors.initials: M
authors.lastname: Lemoine
authors.forename: Abbas
authors.initials: A
authors.lastname: Mourad
authors.forename: Laetitia
authors.initials: L
authors.lastname: Fartoux
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.forename: Jean
authors.initials: J
authors.lastname: Henrion
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Lawrence
authors.initials: L
authors.lastname: Serfaty
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000378:metabolism* / Q000821:virology; D006801:Humans; D007333:Insulin Resistance; D016898:Interferon-alpha / Q000008:administration & dosage*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin