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lüll Is pre-treatment liver biopsy necessary for all hepatitis C genotypes?Peltekian KM; Bain VG; Lee SS; Sherman M; Cooper CL; Yoshida EM; Marotta PJ; Krajden M; Balshaw R; Deschenes MAnn Hepatol 2011[Jul]; 10 (3): 260-9BACKGROUND: 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-naive 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.|*Practice Guidelines as Topic[MESH]|Adult[MESH]|Antiviral Agents/pharmacology/therapeutic use[MESH]|Biopsy[MESH]|Dose-Response Relationship, Drug[MESH]|Female[MESH]|Genotype[MESH]|Hepacivirus/drug effects/*genetics[MESH]|Hepatitis C/drug therapy/*genetics/*pathology[MESH]|Humans[MESH]|Interferon alpha-2[MESH]|Interferon-alpha/pharmacology/therapeutic use[MESH]|Liver/*pathology/virology[MESH]|Male[MESH]|Middle Aged[MESH]|Polyethylene Glycols/pharmacology/therapeutic use[MESH]|Recombinant Proteins[MESH]|Retrospective Studies[MESH]|Ribavirin/pharmacology/therapeutic use[MESH]|Treatment Outcome[MESH] |