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Predictive value of the HOMA-IR?
I found this excerpt interesting.
".....A surprising finding of our study is the lack of predictive value of the HOMA-IR. The clinical significance of determining the HOMA-IR score before therapy is debated. Initial studies showed that chronic hepatitis C patients with HOMA-IR score <2 had significantly better chances of achieving SVR, independent of the HCV genotype.[6,8,35,36] The predictive value of HOMA-IR was further reported in patients of Asian[35,37,38] or Middle East ancestry.[36,39] However, recent works have failed to confirm these findings,[40–42] and a similar controversy exists for chronic hepatitis C patients coinfected with HIV.[43–45] Higher HOMA-IR scores and/or insulin levels are inversely correlated with the HCV RNA decay occurring during the first days[46–48] or weeks[49,50] of therapy. In our study, we observed an association between HOMA-IR and RVR only in the genotype 3 subgroup (by univariate analysis), but no association was seen when carrying out the multivariate analysis for RVR or with SVR for any viral genotype. It is possible, however, that associations between HOMA-IR and SVR rate be confounded by several factors (e.g. adherence). In addition, it is possible that discrepancies among studies be accounted for by differences among the patients' populations, especially in terms of prevalence of central obesity. Furthermore, the accuracy of HOMA-IR score assessment has been criticised and recent work suggests that, especially in lean and/or non-obese patients, HOMA-IR may be burdened by lack of standardisation.[51] Thus, the future significance of assessing IR by HOMA-IR before treatment seems questionable, especially at a time when patients' stratification before therapy is better achieved by genomic-based assays....."
http://www.medscape.com/viewarticle/741931_4
The entire article is entitled:
IL28B Polymorphisms, IP-10 and Viral Load Predict Virological Response to Therapy in Chronic Hepatitis C
See: http://www.medscape.com/viewarticle/741931
It's a medscape article and you must be registered to view. It's free and easy to register and it's well worth the time and effort.
Mike
".....A surprising finding of our study is the lack of predictive value of the HOMA-IR. The clinical significance of determining the HOMA-IR score before therapy is debated. Initial studies showed that chronic hepatitis C patients with HOMA-IR score <2 had significantly better chances of achieving SVR, independent of the HCV genotype.[6,8,35,36] The predictive value of HOMA-IR was further reported in patients of Asian[35,37,38] or Middle East ancestry.[36,39] However, recent works have failed to confirm these findings,[40–42] and a similar controversy exists for chronic hepatitis C patients coinfected with HIV.[43–45] Higher HOMA-IR scores and/or insulin levels are inversely correlated with the HCV RNA decay occurring during the first days[46–48] or weeks[49,50] of therapy. In our study, we observed an association between HOMA-IR and RVR only in the genotype 3 subgroup (by univariate analysis), but no association was seen when carrying out the multivariate analysis for RVR or with SVR for any viral genotype. It is possible, however, that associations between HOMA-IR and SVR rate be confounded by several factors (e.g. adherence). In addition, it is possible that discrepancies among studies be accounted for by differences among the patients' populations, especially in terms of prevalence of central obesity. Furthermore, the accuracy of HOMA-IR score assessment has been criticised and recent work suggests that, especially in lean and/or non-obese patients, HOMA-IR may be burdened by lack of standardisation.[51] Thus, the future significance of assessing IR by HOMA-IR before treatment seems questionable, especially at a time when patients' stratification before therapy is better achieved by genomic-based assays....."
http://www.medscape.com/viewarticle/741931_4
The entire article is entitled:
IL28B Polymorphisms, IP-10 and Viral Load Predict Virological Response to Therapy in Chronic Hepatitis C
See: http://www.medscape.com/viewarticle/741931
It's a medscape article and you must be registered to view. It's free and easy to register and it's well worth the time and effort.
Mike
Thank you for the study; very interesting and it serves to remind us that this is not yet a solid "known". We may see further studies clarify the situation.
The thing that I would add is that the IR issue becomes even more tenuous when treating with a PI. PI's tend to make IR or genetic testing less important than w/ straight SOC.
Willy
The thing that I would add is that the IR issue becomes even more tenuous when treating with a PI. PI's tend to make IR or genetic testing less important than w/ straight SOC.
Willy
Thx. for posting that....just when we figure we know the rules they go and change them somewhat :)
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