Insulin resistance (IR) has been suggested to be such a factor for double therapy with pegylated interferon/ribavirin. Younossi et al. review the data of the phase III REALIZE trial regarding the predictive value of homeostatic model assessment for IR (HOMA-IR). In this population of patients who failed previous double therapy, HOMA-IR was not associated with response in multivariate analysis and therefore is not helpful in clinical decision making in this context. (Hepatology selleck products 2013;58:1897-1906.) Treatment of hepatitis B with nucleos(t)ide analogs is very effective and easy to initiate, but much more difficult
to stop. The optimal duration of the treatment has important compliance and cost implications. Jeng et al. investigated the “APASL stopping rule” based on hepatitis B virus (HBV) viremia. They assessed the outcome of hepatitis B e antigen–negative patients who stopped entecavir after three negative HBV viremia determinations 6 months apart. In the year after cessation of treatment, hepatitis B relapsed in 45% of the patients. The relapse rate was 29% in patients Alectinib in vitro with a baseline viremia lower
than 2 × 105 IU/mL, the only identified predictive factor. These results may provide some guidance regarding when to stop oral treatment of HBV, but one should remain cautious, particularly with patients with cirrhosis. Rarely, withdrawal can trigger a flare with liver failure. (Hepatology 2013;58:1888-1896.)
Survival of patients treated for HCC can be divided into two distinct periods: the time up to progression and the time after progression. Since the SHARP trial, time to progression (TTP) has been used as the surrogate endpoint for overall survival. However, the factors determining postprogression survival have not been investigated. Intuitively, the pattern of progression should affect postprogression survival. Reig et al. performed this analysis in their collection of sorafenib-treated patients who demonstrated a progression. First, they show that TTP is indeed an independent predictor of overall survival, along with Child-Pugh progression. Second, they report that the Barcelona Clinic Liver Cancer stage at progression and the presence of new extrahepatic lesions or vascular invasion are independent predictors of postprogression survival. learn more In an era of second-line trials, these results have evident implications. (Hepatology 2013;58:2023-2031.) Studies investigating variceal bleeding typically exclude patients with HCC, so the outcome of variceal bleeding in these patients is unknown. Ripoll et al. matched 146 HCC patients with 146 without HCC for age and Child-Pugh class; all were admitted for variceal bleeding. Patients with HCC received secondary prophylaxis significantly less frequently and this was associated with shorter survival on multivariate analysis.