Predicting patients with chronic hepatitis C in need of early treatment

Predicting patients with chronic hepatitis C in need of early treatment
Alimentary Pharmacology & Therapeutics
Volume 40, Issue 8, pages 863–879, October 2014

October's issue of the Alimentary Pharmacology & Therapeutics reviewed predictive models that identify patients with chronic hepatitis C in need of early treatment and intensive monitoring

Advances in hepatitis C therapies have led to increasing numbers of patients seeking treatment.

As a result, logistical and financial concerns regarding how treatment can be provided to all patients with chronic hepatitis C have emerged.

Dr Konerman and colleagues from Michigan, USA evaluated predictors and predictive models of histological progression and clinical outcomes for patients with CHC.

MEDLINE via PubMed, EMBASE, Web of Science and Scopus were searched for studies published between January 2003 and June 2014.

There were 2 authors that independently reviewed articles to select eligible studies and performed data abstraction

The researchers identified 29 studies representing 5817 patients from 20 unique cohorts.

The outcome incidence rates were widely variable, including 16–61% during median follow-up of 3 to 10 years for fibrosis progression, 13–40% over 2 to 14 years for hepatic decompensation, and 8–47% over 4 to 14 years for overall mortality.

The researchers showed that baseline steatosis and baseline fibrosis score were the most consistent predictors of fibrosis progression, while baseline platelet count, aspartate and alanine aminotransferase ratio, albumin, bilirubin and age were the most consistent predictors of clinical outcomes.

The team found 5 studies that developed predictive models but none were externally validated.
Dr Konerman's team concludes, "Our review identified the variables that most consistently predict outcomes of patients with chronic hepatitis C allowing the application of risk based approaches to identify patients in need of early treatment and intensive monitoring."

"This approach maximises effective use of resources and costly new direct-acting anti-viral agents."

Aliment Pharmacol Ther 2014: 40(8): 863–879