title: Predictive value of FIB-4 and APRI versus METAVIR on sustained virologic response in genotype 1 hepatitis C patients.
abstract: OBJECTIVE
  Advanced liver fibrosis is a negative predictor of virologic response in genotype 1 chronic hepatitis C (CHC) patients. Biopsy, however, is invasive, costly, and carries some risk of complications.
  
  
  METHODS
  Using data from the prospective, international cohort study PROPHESYS, we assessed two alternative noninvasive measures of fibrosis, the FIB-4 and AST-to-platelet ratio index (APRI), to predict virologic response in CHC patients.
  
  
  RESULTS
  CHC genotype 1, monoinfected, treatment-naive patients prescribed peginterferon alfa-2a (40 KD)/ribavirin in accordance with country-specific legal and regulatory requirements and who had baseline METAVIR, FIB-4, and APRI scores (N = 1,592) were included in this analysis. Patients were stratified according to the baseline METAVIR, FIB-4, or APRI score to assess virologic response [hepatitis C virus (HCV) RNA <50 IU/mL] by week 4 of treatment (rapid virologic response) and 24 weeks after untreated follow-up ]sustained virologic response (SVR)]. Baseline predictors of SVR were explored by multiple logistic regression, and the strength of the association between each fibrosis measure and SVR was evaluated. Both FIB-4 and APRI scores increased with increasing levels of biopsy-assessed fibrosis. The association between FIB-4 and SVR (p < 0.1 × 10(-30)) was stronger than that between METAVIR (p = 3.86 × 10(-13)) or APRI (p = 5.48 × 10(-6)) and SVR. Baseline factors significantly associated with SVR included male gender, lower HCV RNA, lower FIB-4 score, no steatosis, and higher alanine aminotransferase ratio.
  
  
  CONCLUSIONS
  The FIB-4 index provides a valuable, noninvasive measure of fibrosis and can be used to predict virologic response in patients treated with peginterferon alfa-2a (40  KD)/ribavirin.
authors.affiliation: Internal Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. peter.ferenci@meduniwien.ac.at.
authors.forename: Peter
authors.initials: P
authors.lastname: Ferenci
authors.affiliation: The Goiás Federal University Clinical Hospital, Goiânia, Brazil. rsaires@uol.com.br.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Aires
authors.affiliation: Asheville Gastroenterology Associates, Asheville, NC, USA. kimberly.beavers.MD@ashevillegastro.com.
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Beavers
authors.affiliation: University of Medicine and Pharmacy of Timisoara, Timisoara, Romania. manuela.curescu@gmail.com.
authors.forename: Manuela
authors.initials: M
authors.lastname: Curescu
authors.affiliation: Division of Infectious Disease, Federal University of São Paulo, São Paulo, Brazil. paulo.abrao.ferreira@gmail.com.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Abrão Ferreira
authors.affiliation: 4th Department of Internal Medicine, Wilhelminenspital, Vienna, Austria. Michael.Gschwantler@wienkav.at.
authors.forename: Michael
authors.initials: M
authors.lastname: Gschwantler
authors.affiliation: Central Military Hospital, Bucharest, Romania. drstefanion@gmail.com.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ion
authors.affiliation: Liver Unit, Saint Eloi Hospital, Montpelier, France. dom-larrey@chu-montpellier.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Larrey
authors.affiliation: University Medical Centre, Ljubljana, Slovenia. mojca.maticic@kclj.si.
authors.forename: Mojca
authors.initials: M
authors.lastname: Maticic
authors.affiliation: SC Malattie Infettive dell' AO Ospedale Niguarda Cà Granda, Milan, Italy. massimopuoti@libero.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
authors.affiliation: Szent Laszlo Hospital, Budapest, Hungary. schuller@lamb.hu.
authors.forename: János
authors.initials: J
authors.lastname: Schuller
authors.affiliation: 2nd Department of Internal Medicine, Medical University, Debrecen, Hungary. itornai@med.unideb.hu.
authors.forename: Istvan
authors.initials: I
authors.lastname: Tornai
authors.affiliation: Infectology Department, Hetényi Géza Hospital, Szolnok, Hungary. a.tusnadi@chello.hu.
authors.forename: Anna
authors.initials: A
authors.lastname: Tusnádi
authors.affiliation: IST GmbH, Mannheim, Germany. diethelm.messinger@istgmbh.com.
authors.forename: Diethelm
authors.initials: D
authors.lastname: Messinger
authors.affiliation: F. Hoffmann-La Roche Ltd, Basel, Switzerland. fernando.tatsch@roche.com.|AbbVie, Chicago, USA. fernando.tatsch@roche.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Tatsch
authors.affiliation: Warsaw Medical University, Warsaw, Poland. ahorban@zakazny.pl.|Hospital of Infectious Diseases, Warsaw, Poland. ahorban@zakazny.pl.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Horban
keywords: APRI; FIB-4; METAVIR; Noninvasive fibrosis measure; Peginterferon alfa-2a