Report from EASL; The European Association for the Study of the Liver Conference, Rotterdam, April 28-May 3, 2000 - Report 12, Tuesday

In this evening's Roche sponsored symposium, the response of cirrhotics in the Pegasys (Peg IFN alfa-2a) study reported yesterday was discussed. Thirteen percent of participants in this study of 531 people overall had cirrhosis at the time of entry. This study compared Pegasys to IFN alfa-2a (regular IFN). The regular IFN arm used an induction regimen of 6 MIU 3x/week for 12 weeks followed by 3 MIU. This regimen is used outside the USA. They reported that 45% of study participants with cirrhosis or transition to cirrhosis had a sustained virlologic (undetectable, <100 copies/ml) response (72 weeks). However, they were unable to report the response rate for genotype 1 because the data wasn't available yet. They cautioned that the number of patients in the analysis of this subgroup is small. In a larger study of Pegasys in cirrhotics reported by Jenny Heathcote at last November's AASLD meeting, 30% of cirrhotics overall had a sustained response, but only 10% with genotype 1 and cirrhosis had a sustained response.
 

CHRONIC LIVER DISEASE: DIABETES and BONE MASS  (EASL abstracts)

What are the responsible factors of the development of diabetes mellitus in chronic liver disease?

Although an increased prevalence of diabetes mellitus (DM) in chronic liver disease is known for many years, the responsible factors for the development of DM are inconclusive. The aim of this retrospective study is to identify the facilitating factors (age, sex, etiology of liver disease duration of liver disease, biochemical findings, stage of chronic hepatitis, Child's class) resulting in DM in 659 chronic hepatitis patients and 689 cirrhotic patients by using uni- and multivariate analysis. The age-matched materials of 23,679 cases of a previous study about the frequency of DM in community was accepted as a control group [Diabetes 1998; 47(suppl 1):A384]. Chronic hepatitis patients were constituted of 5 subgroups (306 HBV, 269 HCV, 37 autoimmune, 33 HDV, 14 HBV+HCV), and cihhotic patients 8 subgroups (208 HBV, 144 HCV, 94 cryptogenic, 77 cholestatic, 70 HDV, 63 alcohol, 27 autoimmune, 6 HBV+HCV).

The prevalence of DM was 3.7% in controls, 5.8% in chronic hepatitis (p<0.01), and 12.7% in liver cirrhosis (p<0.001, p<0.001, respectively). Although the rate of DM was not significantly different among chronic hepatitis subgroups, 12.9% of patients in stage II and 3.1% of stage I (p<0.01).  In liver cirrhosis, the prevalence of DM was significantly higher (p<0.05-0.001) in HCV-related cirrhosis (25.6%) than in all other subgroups except the HBV+HCV related cirrhosis. DM was more frequently occurred in Child's C than in both Child's A and B (p<0.05). Multi-variate analysis showed that age (p<0.001) and HCV in liver cirrhosis, and age (p<0.001) in chronic hepatitis were independent predictors for DM. As a result, DM more commonly develops in chronic liver disease than in community. The risk of DM increases with the progression of liver disease and the advance of age. In cirrhotic patients, it seems that chronic HCV infection is an additional risk factor for DM.

Bone Mass and Chronic Viral Hepatitis

M Auletta, V Nuzzo, F Fonderico, MR Fittipaldi, S Antonielli, G Lupoli

Dept of Clinical Medicine and Cardiovascular Sciences, and Dept of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples. Italy

The liver plays a central role in bone metabolism. Several studies reported low bone mineral density (BMD) in chronic liver disease especially cholestatic, alcoholic, corticosteroid-treated chronic hepatitis, hemochromatosis. The aim of this study was to examine the prevalence of osteoporosis and/or osteopenia in a consecutive series of patients affected by chronic viral hepatitis. Twenty-five male patients, aged 41-59 years, affected by biopsy-proven chronic hepatitis correlated to C virus were studied. Exclusion criteria were: body mass index (BMI) <20 and >25 Kg/m2, hyperbilirubinemia, advanced liver cirrhosis, cholestatic and alcoholic liver disease, previous therapy or disease affecting bone mass. BMD was evaluated by dual energy X-ray absorptiometry (DEXA) at lumbar spine (L1-L4) and femural neck (FN) using a hologic QDR 1000 densitometer.

The results are expressed as BMD (g/cm2), T score (SD from the mean value obtained I 30 year old subjects) and Z score (SD from mean valu obtained in subjects of the same age & sex). Serum calcium, phosphorous, ALP, gonadotropins, testosterone, thyroid hormones, cortisol, PTH, urinary calcium, and hydroxyproline were evaluated. A complete clinical, biochemical and ultrasonographic evaluation of liver disease was performed.

The results showed an alteration of bone mass in 16 out of 25 patients (64%): in fact, T score resulted <-1 SD in 11 (44%), and <2.5 SD in 5 patients (20%). Moreover an inverse correlation (p<0.05) was found only among BMD at lumbar spine, serum calcium and duration of liver disease. At femoral neck a direct correlation between BMD and BMI (p<0.05) and an inverse one between BMD and cortisol (p<0.05) were found. No correlation was found with patient's age. The reduction of BMD in patients with non-advanced viral liver disease suggests that more attention should be paid to BMD in patients without cholestasis, alcoholic consumption, malnutrition, and/or factors affecting bone metabolism.