As part of AP&T’s peer-review process, a technical check of this meta-analysis was performed by Dr. P. Collins.
Meta-analysis: insulin resistance and sustained virological response in hepatitis C
Article first published online: 29 MAY 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 34, Issue 3, pages 297–305, August 2011
How to Cite
Eslam, M., Aparcero, R., Kawaguchi, T., Del Campo, J. A., Sata, M., Khattab, M. A. and Romero-Gomez, M. (2011), Meta-analysis: insulin resistance and sustained virological response in hepatitis C. Alimentary Pharmacology & Therapeutics, 34: 297–305. doi: 10.1111/j.1365-2036.2011.04716.x
- Issue published online: 4 JUL 2011
- Article first published online: 29 MAY 2011
- Publication data , Submitted 15 February 2011, First decision 28 March 2011, Resubmitted 7 May 2011, Accepted 8 May 2011, EV Pub Online 29 May 2011
Aliment Pharmacol Ther 2011; 34: 297–305
Background A higher baseline homeostasis model assessment of insulin resistance (HOMA-IR) score has sometimes predicted a poorer sustained virological response (SVR) rate to peginterferon/ribavirin therapy in treatment-naïve chronic hepatitis C patients.
Aim To perform 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 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: 1.97–4.16)] in comparison with insulin resistance. Moreover, in separate analysis by genotype selecting studies that used HOMA-IR > 2 as cut-off defining insulin resistance, SVR was higher in patients with HOMA-IR < 2 in all genotypes: HCV-1 [OR: 2.16 (95%CI: 1.51–3.08)], HCV-2&3 [OR: 3.06 (95%CI: 1.06–8.82)] and HCV-4 [OR: 6.65(95%CI: 2.51–17.61)]. Studies reporting no association between HOMA and SVR included easy-to-cure cohorts, analysed variables strongly related with insulin resistance 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 insulin resistance, susceptible to some biases derived from both handling and interpretation.