castera pb halternative 2
TRANSCRIPT
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7.1
Fibrose significative (n=1307 patients atteints d’hépatites virales, 746 F2)
3 75
F 275%
50%
F < 2 61%
50%
AUROC=0.76 Bien classés 68 %
Degos et al. J Hepatol 2010; 53: 1013-21
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Friedrich-Rust et al. Gastroenterology 2008; 134: 960-74
AUROC: 0.84 (0.82-0.86)
Seuil optimal: 7.6 kPa
Performances diagnostiques pour F≥2 Meta-analyse
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12.93 75
F = 453%
19%
F < 4 95%
81%
AUROC=0.90 patients bien classés 87 %
Degos et al. J Hepatol 2010; 53: 1013-21
Performance diagnostique pour cirrhose(n=1307 patients avec hépatites virales, 180 cirrhotiques)
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Friedrich-Rust et al. Gastroenterology 2008; 134: 960-74
AUROC: 0.94 (0.93-0.95)
Optimal cut-off: 13.0 kPa
Performances diagnostiques pour F4 Meta-analyse
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Principe
Performances diagnostiques
Comparaison avec les biomarqueurs
Suivi de la progression de la fibrose
Limites & perspectives
Plan
Comparaison avec les biomarqueurs
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Castera et al. Gastroenterology 2005; 128: 343-50.Castera et al. Gastroenterology 2005; 128: 343-50.
Comparaison des approchesfibrose significative
P=NS
Degos et al. J Hepatol 2010; 53: 1013-21
P=NS
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N= 298 CHC patients; F4: 25%
Comparaison des approchescirrhose
1,00,80,60,40,20,0
1 - Specificity
1,0
0,8
0,6
0,4
0,2
0,0
Se
ns
itiv
ity
.
F0123 vs F4
APRI
Lok
FT
FS
Platelet
PI
AAR
0.96
0.84
0.82
0.82
0.80
0.76
0.67
P<0.001
Castera et al. J Hepatol 2009; 50: 59-68.Castera et al. J Hepatol 2009; 50: 59-68.
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N= 1307 patients; F4: 25%.
P<0.0001
Comparaison des approchescirrhose
Degos et al. J Hepatol 2010; 53: 1013-21
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N= 436 patients; F4: 14%.
Comparaison des approchescirrhose
Zarski et al. J Hepatol 2012; 56: 55-62
ZARSKI
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Summary: significant fibrosis
Transient elastographySerum markers
=
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Summary: cirrhosis
Transient elastographySerum markers
<
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Qu’en est-il de la combinaison Qu’en est-il de la combinaison
des méthodes?des méthodes?
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La combinaison augmente les performances diagnostiques
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Castera et al. Gastroenterology 2005; 128: 343-50.Castera et al. Gastroenterology 2005; 128: 343-50.
ElastométrieMarqueurs sériques
+Bien
classés F≥2:
75%
La combinaison augmente les performances diagnostiques
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Poynard et al. Plos One 2008
Concordance in world without gold standard:Concordance in world without gold standard:a new way to increase diagnostic accuracya new way to increase diagnostic accuracy
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Boursier et al. Am J Gastroenterol 2011; 106: 1255-63
N= 729 patients with CHC
La combinaison augmente les performances diagnostiques
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APRI
Sebastiani et al. J Hepatol 2006; 44: 686-93.
F2-F3-F4(>95% accuracy)
F0-F1(20-30% false -)
F0-F1(20-30% false -)
F2-F3-F4(>95% accuracy)
Unclassified
FIBROTEST
LIVER BIOPSY Liver biopsy not needed
Combinaison des marqueurs sériquesSequential Algorithm for Fibrosis Evaluation
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Comparaison des algorithmesfibrose significative
Sebastiani et al. J Hepatol 2006; 44: 686-93.
PBH évitées: 48%
Padoue
?
Bordeaux
Castéra et al. J Hepatol 2010; 52: 191-8.
PBH évités: 72%<P<0.001
N=302 HCV patients
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Comparaison entre algorithmesCirrhose
Sebastiani et al. J Hepatol 2006; 44: 686-93.
PBH évitées: 75%
Padova
?
Bordeaux
Castéra et al. J Hepatol 2010; 52: 191-8.
PBH évitées: 79%=
N=302 HCV patients
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• Good reproducibility• High applicability (95%)• Low cost & wide
availability (non patented)
• AdvantagesFibroScan
• Genuine property of the liver• High performance for cirrhosis• User-friendly
• AdvantagesBiomarkers
• Disadvantages
• Non specific of the liver• Performance for cirrhosis• Cost & availability
(patented)
• Disadvantages
• Low applicability (80%)• False positive (inflammation)• Requires a dedicated device-
Biomarkers vs. FibroScansummary
Castera L . Gastroenterology 2012; 142: 1293-302
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Comment utiliserComment utiliser
les méthodes non invasive les méthodes non invasive
en pratique?en pratique?
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Hepatitis C: Decision to treat
Antiviral
treatment
IL28B
Foie
HCV genotype
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Transient elastographySerum markers
or
+
Naive patients without comorbidities
Haute Autorite de Santé, 2008Haute Autorite de Santé, 2008 EASL HCV Clinical Practice Guidelines J Hepatol 2011EASL HCV Clinical Practice Guidelines J Hepatol 2011
Use as first line assessment
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Algorithm for clinical practice
Castera L . Gastroenterology 2012; 142: 1293-302
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Is diagnosing significant fibrosisIs diagnosing significant fibrosis
still important in the era of DAAs ? still important in the era of DAAs ?
F0 F1 F2 F3 F4
Boceprevir Telaprevir
?
Indication for antiviral treatment
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Is diagnosing significant fibrosisIs diagnosing significant fibrosis
still important in the era of DAAs ? still important in the era of DAAs ?
F0 F1 F2 F3 F4
Boceprevir Telaprevir
?
Indication for antiviral treatment
HVPG>10
Significant risk of OV bleeding
Clinical complications
HVPG>12
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Liver stiffness: a wide range of value in cirrhosis
75 kPa3
15 655.5
Normal Cirrhosis
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Principe
Performances diagnostiques
Comparaison avec les biomarqueurs
Suivi de la progression de la fibrose
Limites & perspectives
Plan
Suivi de la progression de la fibrose