Noninvasive Markers for Assessment of Fibrosis in Chronic
Liver Disease: Are They Ready for Prime Time?
Over
the past decade, there has been a renewed enthusiasm to develop
noninvasive serum markers or tests to assess the presence
and severity of fibrosis
in chronic liver disease. Although a single marker or test
has lacked the necessary accuracy to predict fibrosis, different
combinations of these markers or tests have shown encouraging
results.
However, inter-laboratory variability and inconsistent results
with liver diseases of varying etiologies have made it difficult
to assess the reliability of these markers in clinical practice.
In the September 2005 issue of the The American Journal of Gastroenterology,
Poynard and colleagues describe the “histological”
response to lamivudine
(Epivir-HBV) in patients with chronic
HBV infection over a 24-month period using
surrogate serum biomarkers (FibroTest-ActiTest)
without corroborating histological data.
Investigators found improvement in fibrosis and
inflammation in 85% and 91%, respectively, despite the emergence
of YMDD
mutation in 41.5% of patients.
The
higher improvement rates reported in this study should be
interpreted with caution for a number of reasons including
the absence of data on virological response rates, corroboratory
histological data, and data on the validity of FibroTest to
evaluate fibrosis in a longitudinal manner.
Although FibroTest has been studied extensively by the authors
of the current study, to date there are only few independent
studies. In addition to significant inter-laboratory variations,
these studies have shown that significant fibrosis could be
missed, or conversely significant fibrosis diagnosed in the
absence of minimal or no fibrosis in about 15–20% of patients.
In the conclusion of their commentary on the reliability of
non invasive markers, the authors write, “We may be approaching
a time when serum biomarkers may become an integral part of
the assessment of patients with chronic liver disease, but
published evidence suggests that these markers are not yet
ready for prime time.”
10/05/05
Reference
P
J Thuluvath and K L Krok. Noninvasive Markers of Fibrosis
for Longitudinal Assessment of Fibrosis in Chronic Liver
Disease: Are They Ready for Prime Time? (Editorial) The
American Journal of Gastroenterology 100(10): 1981-1983. September 2005.
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