Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta-Analysis

Friedrich‐Rust, Mireen; Ong, Mei Fang; Martens, Swantje; Sarrazin, Christoph; Bojunga, Joerg; Zeuzem, Stefan; Herrmann, Eva

doi:10.1053/j.gastro.2008.01.034

Cited by 1,320 publications

(1,130 citation statements)

References 76 publications

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“…More than 100 clinical studies correlating ultrasound elastography with liver biopsy have appeared since its first description in 2003, 100 including meta-analyses. [101][102][103] These show a good correlation of stiffness values with the histological stage of fibrosis. Area under receiver operating curves (that reflect the diagnostic precision in select populations) yielded excellent accuracy for differentiating cirrhosis from noncirrhosis (AUROC between 0.90 and 0.99), especially for patients with chronic hepatitis C. However, with the practical but crude histological Metavir staging system (with F1 ϭ mild, periportal fibrosis, and F4 ϭ cirrhosis), there is high overlap between the lower stages, only part of which can be attributed to biopsy sampling variability.…”

Section: Noninvasive Means To Assess Liver Fibrosis and Fibrogenesismentioning

confidence: 64%

Targeting Liver Fibrosis

2009

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We have made striking progress in our understanding of the biochemistry and cell biology that underlies liver fibrosis and cirrhosis, including the development of strategies and agents to prevent and reverse fibrosis. However, translation of this knowledge into clinical practice has been hampered by (1) the limitation of many in vitro and in vivo models to confirm mechanisms and to test antifibrotic agents, and (2) the lack of sensitive methodologies to quantify the degree of liver fibrosis and the dynamics of fibrosis progression or reversal in patients. Furthermore, whereas cirrhosis and subsequent decompensation are accepted hard clinical endpoints, fibrosis and fibrosis progression alone are merely plausible surrogates for future clinical deterioration. In this review we focus on an optimized strategy for preclinical antifibrotic drug development and highlight the current and future techniques that permit noninvasive assessment and quantification of liver fibrosis and fibrogenesis. The availability of such noninvasive methodologies will serve as the pacemaker for the clinical development and validation of potent antifibrotic agents. (HEPATOLOGY 2009;50:1294-1306

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Section: Noninvasive Means To Assess Liver Fibrosis and Fibrogenesismentioning

confidence: 64%

Targeting Liver Fibrosis

2009

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“…For patients without a liver biopsy, fibrosis stage was determined by FibroScan Ò results using a cut-off value of 9.5 kPa to indicate fibrosis stage PF3 (<9.5 kPa F0-F2; P9.5 kPa F3-F4), consistent with evaluations of the use of FibroScan Ò in chronic HCV [18,19]; however, there are no reliable cut-offs in the literature for distinguishing <F3 from PF3. The FibroScan Ò threshold for cirrhosis was P13 kPa, based on the results of a meta-analysis by Friedrich-Rust et al, and consistent with results of other studies [20,21]. Main exclusion criteria included mixedgenotype HCV; HIV or hepatitis B co-infection; decompensated liver disease; and contraindications to PegIFN or RBV.…”

Section: Patientsmentioning

confidence: 79%

“…Another potential limitation is the lack of baseline histology data on many patients due to the widespread use of FibroScan Ò in Europe. For patients without liver biopsies, we relied on FibroScan Ò scores to stage fibrosis; although the FibroScan Ò cut-off for cirrhosis is quite established, there is some disagreement about the optimal cut-off value for distinguishing <F3 from PF3 fibrosis [18][19][20][21]. Nevertheless, there is no gold standard for defining fibrosis stage at all, since sampling error is a major problem with inadequate sized liver biopsies [32].…”

Section: Discussionmentioning

confidence: 99%

STARTVerso1: A randomized trial of faldaprevir plus pegylated interferon/ribavirin for chronic HCV genotype-1 infection

Ferenci

Asselah

Foster

et al. 2015

Journal of Hepatology

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Background & Aims:The efficacy and tolerability of faldaprevir, a potent hepatitis C virus (HCV) NS3/4A protease inhibitor, plus peginterferon (PegIFN) and ribavirin (RBV) was assessed in a double-blind, placebo-controlled phase 3 study of treatment-naïve patients with HCV genotype-1 infection. Methods: Patients were randomly assigned (1:2:2) to PegIFN/ RBV plus: placebo (arm 1, n = 132) for 24 weeks; faldaprevir (120 mg, once daily) for 12 or 24 weeks (arm 2, n = 259); or faldaprevir (240 mg, once daily) for 12 weeks (arm 3, n = 261). In arms 2 and 3, patients with early treatment success (HCV-RNA <25 IU/ml at week 4 and undetectable at week 8) stopped all treatment at week 24. Other patients received PegIFN/RBV until week 48 unless they met futility criteria. The primary endpoint was sustained virologic response 12 weeks post-treatment (SVR12). Results: SVR12 was achieved by 52%, 79%, and 80% of patients in arms 1, 2, and 3, respectively (estimated difference for arms 2 and 3 vs. arm 1: 27%, 95% confidence interval 17%-36%; and 29%, 95% confidence interval, 19%-38%, respectively; p <0.0001 for both). Early treatment success was achieved by 87% (arm 2) and 89% (arm 3) of patients, of whom 86% and 89% achieved SVR12. Adverse event rates were similar among groups; few adverse events led to discontinuation of all regimen components. Conclusions: Faldaprevir plus PegIFN/RBV significantly increased SVR12, compared with PegIFN/RBV, in treatment-naïve patients with HCV genotype-1 infection. No differences were seen in responses of patients given faldaprevir once daily at 120 or 240 mg. Ó

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“…Recently, several noninvasive tools have been introduced to assess the degree of liver fibrosis in patients with chronic hepatitis; these include using serum biochemical markers and transient elastography [12][13][14][15][16]. Among them, the aspartate aminotransferase-platelet ratio index (APRI) appears to be a reliable, simple test that is easy to interpret [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

Hung

Lai

et al. 2010

Hepatol Int

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Purpose Although advanced liver fibrosis is crucial in the development of hepatocellular carcinoma (HCC) for patients with chronic hepatitis B, whether it is associated with the recurrence of HCC after resection remains obscure. This study was aimed to compare the outcomes for patients with minimal or advanced fibrosis in solitary small hepatitis B virus (HBV)-related HCC.Methods This study enrolled 76 patients with small (\5 cm) solitary HBV-related HCC who underwent resection. The outcomes of patients with minimal and advanced fibrosis in non-tumor areas were compared. Serum markers were tested to assess the stage of hepatic fibrosis and to predict prognosis. Results Fourteen patients with an Ishak fibrosis score of 0 or 1 were defined as having minimal fibrosis; the remaining 62 patients were defined as having advanced fibrosis. During a follow-up period of 77.0 ± 50.7 months, 41 patients died. The overall survival rate was significantly higher (P = 0.018) and recurrence rate was lower

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Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta-Analysis

Cited by 1,320 publications

References 76 publications

Targeting Liver Fibrosis

Targeting Liver Fibrosis

STARTVerso1: A randomized trial of faldaprevir plus pegylated interferon/ribavirin for chronic HCV genotype-1 infection

Fibrosis and AST to platelet ratio index predict post-operative prognosis for solitary small hepatitis B-related hepatocellular carcinoma

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