Monitoring Hepatitis C Progression: Assessment of Fibrosis Using Liver Biopsy and Noninvasive Markers

Monitoring of Hepatitis C Progression:
Assessment of Fibrosis Using Liver Biopsy
and Noninvasive Markers

Numerous histologic grading systems (eg, Ishak, METAVIR) have been used in an attempt to semiquantify the degree of hepatic fibrosis and inflammation in patients with chronic hepatitis C.
The major use of these systems is to determine the degree of fibrosis as well as inflammation, and thus the need for treatment and the potential future risk of disease progression. The identification of accurate, minimally invasive serum markers may offer potential advantages over liver biopsy in certain settings.

Dear Colleague:

Liver biopsy, the current standard of care for histologic assessment of patients with hepatitis C, has a number of limitations: it is invasive, samples only a very small part of the organ, and is subject to variation in interpretation. In addition, sampling at a single point in time does not reflect the dynamic process of degradation, formation, and remodeling that occurs in the liver as a result of disease processes and treatment-induced changes. Nevertheless, liver biopsy has always been and remains a valuable tool to evaluate the severity of liver damage in most causes of hepatic injury. Complications of liver biopsy occur infrequently, but patients are generally concerned about these finite, possible risks. New, less-invasive serum markers are currently under evaluation and appear effective in identifying and separating patients with variable degrees of liver fibrosis in conditions like chronic hepatitis C.

This CME newsletter, Monitoring Hepatitis C Progression: Assessment of Fibrosis Using Liver Biopsy and Noninvasive Markers, describes the latest data regarding new serum markers of fibrosis. In addition, I explore the pros and cons of these tests, as well as liver biopsy, and offer some preliminary thoughts as to their most appropriate uses.

Chair
John G. McHutchison, MD
Director, GI/Hepatology Research
Duke Clinical Research Institute
Division of Gastroenterology
Duke University Medical Center
Durham, North Carolina

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Target Audience
This activity is designed for gastroenterologists and hepatology healthcare professionals who treat patients with hepatitis C.

Activity Goal
The goal of this activity is to discuss the role of biochemical and other markers in predicting liver fibrosis and activity and to compare the advantages and disadvantages of these tests with those of liver biopsy.

Learning Objectives
After completing this activity, the physician should be able to:

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Projects In Knowledge is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
Projects In Knowledge designates this educational activity for a maximum of .5 category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

This newsletter is planned and implemented as an independent CME activity in accordance with the ACCME Essential Areas and Policies.

Successful completion for .5 hour of CME credit requires a passing score of 70% or higher on the posttest. Full instructions for submission are included on the posttest accompanying this newsletter.

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Disclosure Information
The Disclosure Policy of Projects In Knowledge requires that faculty participating in a CME activity disclose to the audience: any significant relationship they may have with a pharmaceutical or medical equipment company, product, or service that may be mentioned as part of their presentation; any relationship with the commercial supporter of this activity; if discussion includes 1) therapies that are unapproved for use or are investigational; 2) ongoing research; or 3) preliminary data. Faculty will disclose such discussion.
For complete prescribing information on the products discussed during this CME activity, please see your current Physicians' Desk Reference (PDR).
John G. McHutchison, MD, has received grant/research support from Akros Pharma Inc, Amgen Inc, Bayer, Biomedicines, Bristol-Myers Squibb Company, Cytel Corporation, Fujisawa Healthcare, Inc, Gen-Probe, Gilead Sciences, Inc, IDUN, Isis Pharmaceuticals, Inc, Ortho Diagnostics, Prometheus Laboratories, Inc, Ribozyme Pharmaceuticals, Inc, Roche Pharmaceuticals, Schering-Plough Corporation, SciClone Pharmaceuticals, Triangle Pharmaceuticals, Inc, and Vertex Pharmaceuticals; is a consultant for Amgen Inc, Anadys Pharmaceuticals, Inc, Centocor, Inc, GlaxoSmithKline, InterMune Inc, Isis Pharmaceuticals, Inc, National Genetics Institute, Novartis Pharmaceuticals Corporation, Pfizer Inc, Prometheus Laboratories, Inc, Ribozyme Pharmaceuticals, Inc, and Schering-Plough Corporation; and is on the speakers bureau of InterMune Inc, Roche Pharmaceuticals, and Schering-Plough Corporation.

The opinions expressed in this activity are those of the faculty and do not necessarily reflect those of Projects In Knowledge.

This CME activity is provided by Projects In Knowledge solely as an educational service. Specific patient care decisions are the responsibility of the physician caring for the patient.

This independent CME activity is supported by an educational grant
from Prometheus Laboratories, Inc.

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