Meta-analysis: Insulin resistance and sustained virological response in hepatitis C

Mohammed Eslam (1) , Reyes Aparcero (2) , Takumi Kawaguchi (3) , José A. del Campo (1) , Michio Sata (3) , Mahmoud A Khattab (4) , Manuel Romero-Gomez (1)

1 Unit for The Clinical Management of Digestive Diseases and CIBERehd
2 The Clinical Management of Digestive Diseases and CIBERehd
3 Department of Digestive Disease Information & Research and Department of Medicine
4 Internal Medicine, GIT and hepatology

Background&aim: Higher baseline homeostasis model assessment of insulin resistance (HOMA-IR) score predicted poorer sustained virological response (SVR) rate to peginterferon/ribavirin therapy in treatment-naïve chronic hepatitis C (CHC) patients. We conducted a meta-analysis to evaluate the impact of HOMA-IR on SVR in hepatitis C. Methods: Relevant studies were identified by searching Medline and EMBASE. We identified 17 publications that addressed the influence of insulin resistance (IR) on SVR. The random effect model of Der Simonian and Laird method were used for heterogeneous studies using the Meta-Disc software 1.4, Madrid, Spain. Results: Normal insulin sensitivity was associated with a higher rate of SVR (odds ratio (OR) 2.86 (95% CI: 1.97 to 4.16) in comparison with insulin resistance (IR). Moreover, in separate analysis by genotype selecting studies that used HOMA-IR>2 as cut-off defining IR, SVR was higher in patients with HOMAIR<2 in all genotypes: HCV-1, (O.R.:2.16(95%CI:1.51-3.08), HCV-2&3 (O.R.:3.06(95%CI:1.06-8.82) and HCV-4 (O.R.:6.65(95%CI:2.51-17.61). Studies reporting no association between HOMA and SVR included easy-to-cure cohorts, analyzed variables strongly related with IR like body mass index, steatosis, hyper γGT, age and fibrosis, and reported differences in handling and interpretation of HOMA-IR. Conclusion: Elevated HOMA-IR was associated with a lower cure rate of patients with hepatitis C treated with Peg-IFN-α/ribavirin irrespective of genotype, and the more difficult-to-treat cohort the better the HOMA-IR prediction. HOMA-IR is as a surrogate marker of IR susceptible to some biases derived from both handling and interpretation.

Mots clés: Medicine

Mohammed Eslam, Reyes Aparcero, Takumi Kawaguchi, José A. del Campo, Michio Sata, et al.. Meta-analysis: Insulin resistance and sustained virological response in hepatitis C. Alimentary Pharmacology and Therapeutics, 2011, 34 (3), pp.297. ⟨10.1111/j.1365-2036.2011.04716.x⟩. ⟨hal-00646005⟩