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Modelling cost-effectiveness and health gains of a "universal" vs. "prioritized" HCV treatment policy in a real-life cohort.
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Modelling cost-effectiveness and health gains of a "universal" vs. "prioritized" HCV treatment policy in a real-life cohort.

Hepatology. 2017 Jul 24;:

Authors: Kondili LA, Romano F, Rolli FR, Ruggeri M, Rosato S, Brunetto MR, Zignego AL, Ciancio A, Di Leo A, Raimondo G, Ferrari C, Taliani G, Borgia G, Santantonio TA, Blanc P, Gaeta GB, Gasbarrini A, Chessa L, Erne EM, Villa E, Ieluzzi D, Russo FP, Andreone P, Vinci M, Coppola C, Chemello L, Madonia S, Verucchi G, Persico M, Zuin M, Puoti M, Alberti A, Nardone G, Massari M, Montalto G, Foti G, Rumi MG, Quaranta MG, Cicchetti A, Craxì A, Vella S, PITER Collaborating Group

Abstract
We evaluated the cost-effectiveness of two alternative DAA treatment policies in a real-life cohort of HCV-infected patients: Policy 1 - "universal": treat all patients, regardless of the fibrosis stage; Policy 2 - treat only "prioritized" patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and healthcare system perspective, was applied to the PITER cohort (representative of Italian HCV-infected patients in care). Specifically, 8,125 patients naïve to DAA treatment, without clinical, sociodemographic or insurance restrictions was used to evaluate the policies' cost-effectiveness. The patients' age, fibrosis stage, assumed DAA treatment cost of €15,000/patient and the Italian liver disease costs were used to evaluate Quality-Adjusted Life-Years (QALY) This article is protected by copyright. All rights reserved.

PMID: 28741307 [PubMed - as supplied by publisher]




IFNL4 rs368234815 TT>δG Variant is Associated with Liver Damage in Patients with Non-alcoholic Fatty Liver Disease.
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IFNL4 rs368234815 TT>δG Variant is Associated with Liver Damage in Patients with Non-alcoholic Fatty Liver Disease.

Hepatology. 2017 Jul 24;:

Authors: Petta S, Valenti L, Tuttolomondo A, Dongiovanni P, Maria Pipitone R, Cammà C, Cabibi D, Di Marco V, Fracanzani AL, Badiali S, Nobili V, Fargion S, Grimaudo S, Craxì A

Abstract
BACKGROUND AND AIMS: The IFNL3/4 locus influencing innate immunity regulation has been associated with the severity of hepatitis and fibrosis progression during chronic hepatitis C infection, while contrasting results were reported in NAFLD. In this study, we examined whether rs12979860 and the linked causal rs368234815 variant encoding for the alternative IFNL4 protein variant are associated with liver fibrosis and damage in a large multicenter cohort of patients at risk of NASH. To clarify the mechanism, we also evaluated the impact on interferon-stimulated gene (ISG) hepatic expression in a subset of patients.
METHODS: We considered 946 consecutive Italian individuals at risk of NASH with liver histology evaluated according to Kleiner. The rs368234815 TT>δG, rs12979860 C>T, and PNPLA3 rs738409 C>G polymorphisms were genotyped and ISG hepatic expression (n=16) tested by TaqMan assays.
RESULTS: We found that the rs368234815 TT allele was independently associated with severe F3-F4 fibrosis (OR 1.53, 95% CI 1.15-2.31; P=0.005), as well as with severe (grade 2-3) lobular necroinflammation (OR 1.47, 95% CI 1.14-1.88; P=0.002). The impact of rs368234815 on liver damage was generally more marked in non-obese individuals, where association with severe fibrosis, necroinflammation and also NASH was observed (p<0.05). ISG were hypo-expressed in the liver of patients carrying the IFNL4 rs368234815 TT/TT genotype (p<0.05). Similar results were observed when considering rs12979860 polymorphism, which was in high linkage disequilibrium with rs368234815 (R(2) =0.87).
CONCLUSIONS: The IFNL4 genotype is associated with severity of fibrosis in NAFLD patients of European ancestry, likely by modulating the activation of innate immunity and necroinflammation. This article is protected by copyright. All rights reserved.

PMID: 28741298 [PubMed - as supplied by publisher]




Magnetic resonance elastography assessment of fibrosis in children with NAFLD: promising but not perfect.
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Magnetic resonance elastography assessment of fibrosis in children with NAFLD: promising but not perfect.

Hepatology. 2017 Jul 24;:

Authors: Xanthakos SA, Trout AT, Dillman JR

PMID: 28741294 [PubMed - as supplied by publisher]




Differentiating stages to stratify risk: This is the question.
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Differentiating stages to stratify risk: This is the question.

Hepatology. 2017 Jul 24;:

Authors: Villanueva C, Graupera I, Alvarado E

PMID: 28741289 [PubMed - as supplied by publisher]




Redefining successful treatment of severe alcoholic hepatitis.
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Redefining successful treatment of severe alcoholic hepatitis.

Hepatology. 2017 Jul 24;:

Authors: Lucey MR

PMID: 28741287 [PubMed - as supplied by publisher]