1. FibroMax in the most common liver diseases
FibroMax: a universal biomarker of liver disease
FT in diagnostic of HBV

2. In this Presentation 1. What is FibroMax? 2.
FibroMax in Viral Hepatitis: FibroTest-ActiTest 3.
FibroMax in Steatosis: SteatoTest 4.
FibroMax in non alcoholic steato-hepatitis: NashTest 5.
FibroMax in alcoholic steato hepatitis: AshTest 6.
Meta-analysis
FT in diagnostic of HBV

3. What is FibroMax?
5 tests together to assess liver injuries in HBV, HCV, NAFLD, ALD
Patient Profile
ActiTest
FibroTest
SteatoTest
AshTest
NashTest
FibroMax
For Fibrosis
For Viral activity
For NASH activity
For ASH activity
For Steatosis
FT in diagnostic of HBV

4. FibroMax in Viral Hepatitis
FibroTest-ActiTest presentation
FT in diagnostic of HBV

5. FibroMax ActiTest FibroTest SteatoTest AshTest NashTest For Fibrosis
For Viral activity
For NASH activity
For ASH activity
For Steatosis
FT in diagnostic of HBV

6. FibroMax in viral hepatitis B and C
Relationship between FibroTest and the stage of firbosis and between ActiTest and the grade of Activity
For more information please report to following presentations
FibroTest in the diagnosis of HBV, FibroTest: prognostic value in HBV , FibroTest in the diagnosis of HCV, FibroTest: prognostic value in HCV
Presentations available on
FT in diagnostic of HBV

7. SteatoTest Presentation
FibroMax in Steatosis
SteatoTest Presentation
FT in diagnostic of HBV

8. FibroMax ActiTest FibroTest SteatoTest AshTest NashTest For Fibrosis
For Viral activity
For NASH activity
For ASH activity
For Steatosis
FT in diagnostic of HBV

9. Population at risk of liver steatosis (Millions)
FT in diagnostic of HBV
Bellentani, Dionysos Study, J Hepatol 2001

10. Biomarker activity in steatosis
FibroTest
FibroMax
Alpha2Macroglobulin
ALT
Total Bilirubin
AST
Gamma GT
Triglycerides
Apolipoprotein A1
Cholesterol
Haptoglobin
Glucose
FT in diagnostic of HBV
+ Age, Gender
+ Weight, Height

11. Poynard Comp Hepatol 2005
The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis
Included Patients
Validation group 1
HCV before treatment
N=310
Validation group 2
HCV sustained responders
N=201
quasi-normal characteristics with normal liver tests
only 11% grade 2–4 steatosis.
Validation group 3
Alcoholic liver disease
N=62
more often male, older, had smaller liver biopsies,
more metabolic risk factors,
more extensive fibrosis
more grades 2–4 steatosis
Control group
Healthy blood donors
N=140
Patients included in the 4 groups similar in age with predominance of male subjects (range 61–76%).
The prevalence of steatosis greater than 5% (grades 2 to 4) varied from 11% in hepatitis C virus (HCV) cured patients to 94% in patients with ALD.
In all groups, at least one metabolic risk factor was observed in more than 50% of included patients.
FT in diagnostic of HBV

12. SteatoTest versus GGT and ALT Poynard Comp Hepatol 2005
Relationship between ST, GGT and ALT and the grade of liver steatosis in the 3 validation groups
Validation group 1
SteatoTest
GGT
ALT
Validation group 2
Validation group 3
FT in diagnostic of HBV

13. SteatoTest versus GGT and ALT Poynard Comp Hepatol 2005
Relationship between ST, GGT and ALT and the grade of liver steatosis in the integrated database combining controls, training group and validation groups
AUROC=0.80
AUROC=0.66
AUROC=0.61
SteatoTest
GGT
ALT
FT in diagnostic of HBV

14. SteatoTest versus UltraSonography Poynard et al, Comp Hepato 2005
Biopsy as Gold Standard n=304
SteatoTest
UltraSonography
Significance
Kappa
0.44 ± 0.06
0.32 ± 0.05
0.02
AUROC
0.78 ± 0.03
0.65 ± 0.03
0.001
FT in diagnostic of HBV

15. FibroMax in Non Alcoholic Steato-Hepatitis
NashTest
FT in diagnostic of HBV

16. FibroMax ActiTest FibroTest SteatoTest AshTest NashTest For Fibrosis
For Viral activity
For NASH activity
For ASH activity
For Steatosis
FT in diagnostic of HBV

17. NashTest: AUROC Poynard et al, BMC Gastro 2006
AUROC NASH = 0.83 (SE=0.04)
NashTest for NASH ROC for Kleiner Class
NashTest for NASH 124 validation cases of CYTOL prospective study
-- Nash
-- Borderline Nash
-- No Nash
FT in diagnostic of HBV

18. NashTest versus Biopsy - Poynard et al BMC Gastro 2006
Concordance between NASH predicted by NashTest and predicted by biopsy (in all patients n=257)
Biopsy NT
No Nash
Borderline Nash
Nash 49 11 8 46 77 34 3 21
Kappa Statistic
0.33―0.04
Discordance 1 class
99/257=39%
Discordance 2 classes
11/257=4%
FT in diagnostic of HBV

19. NashTest versus Biopsy - Poynard et al BMC Gastro 2006
Sensitivity, Specificity and predictive values of NashTest for the diagnosis of NASH (in all patients n=257)
Sensitivity
Specificity
PPV
NPV
No Nash
33%
94%
66%
Prevalence= 0.25
81%
Borderline Nash or Nash
88%
50%
74%
Prevalence=0.62
72%
Conclusion
In patients with non-alcoholic fatty liver disease, NashTest, a simple and non-invasive biomarker reliably predicts the presence or absence of NASH.
Among patients with NAFLD, the new generation of biomarkers such as FibroTest, SteatoTest and NashTest will allow better identification of those at risk and reassurance for patients without fibrosis or NASH.
Biomarkers as a first-line estimate of injury in chronic liver diseases should reduce the need for liver biopsy
FT in diagnostic of HBV

20. Proposed screening strategy of advanced fibrosis, steatosis and NASH in NAFLD patients.
FT in diagnostic of HBV

21. FibroMax in Alcoholic Steato-Hepatitis
AshTest
FT in diagnostic of HBV

22. FibroMax ActiTest FibroTest SteatoTest AshTest NashTest For Fibrosis
For Viral activity
For NASH activity
For ASH activity
For Steatosis
FT in diagnostic of HBV

23. AshTest versus AST/ALT and Maddrey Thabut et al, J Hepatol 2006
Diagnostic values of AshTest, Maddrey and AST/ALT ratio for the diagnosis of alcoholic hepatitis (225 patients 299 controls)
AshTest AUROC=0.89
AST/ALT AUROC=0.78
Maddrey AUROC=0.78
FT in diagnostic of HBV

24. AshTest versus AST/ALT and Maddrey Thabut et al, J Hepatol 2006
ROC curves of AshTest, Maddrey and AST/ALT ratio for the diagnosis of alcoholic hepatitis (n=225).
Conclusions
In heavy drinkers, AshTest is a simple and non-invasive quantitative estimate of alcoholic hepatitis.
The use of AshTest may reduce the need for liver biopsy, and therefore allow an earlier treatment of alcoholic hepatitis.
Conclusions
AshTest
AST/ALT
Maddrey
FT in diagnostic of HBV

25. ASH screening and treatment strategy
Proposed screening strategy of severe alcoholic steatohepatitis (ASH) in excessive drinkers
ASH screening and treatment strategy
FT in diagnostic of HBV

26. Fibrosis screening strategy in ALD patient
Proposed screening strategy of severe alcoholic steatohepatitis (ASH) in excessive drinkers
Fibrosis screening strategy in ALD patient
FT in diagnostic of HBV