et al. Complementary role of vitamin D deficiency and the interleukin-. 28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C.
HEPATOLOGY, Vol. 62, No. 5, 2015
References 1. Garcıa-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, FernandezRodrıguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fibrosis and response to hepatitis C virus therapy: a meta-analysis. HEPATOLOGY 2014;60:1541-1550. 2. Kitson MT, Sarrazin C, Toniutto P, Eslick GD, Roberts SK. Vitamin D level and sustained virologic response to interferon-based antiviral therapy in chronic hepatitis C: a systematic review and meta-analysis. J Hepatol 2014;61:1247-1252. 3. Bitetto D, Fattovich G, Fabris C, Ceriani E, Falleti E, Fornasiere E, et al. Complementary role of vitamin D deficiency and the interleukin28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. HEPATOLOGY 2011;53:1118-1126. 4. Falleti E, Bitetto D, Fabris C, Fattovich G, Cussigh A, Cmet S, et al. Vitamin D binding protein gene polymorphisms and baseline vitamin D levels as predictors of antiviral response in chronic hepatitis C. HEPATOLOGY 2012; 56:1641-1650. 5. Bitetto D, Bortolotti N, Falleti E, Vescovo S, Fabris C, Fattovich G, et al. Vitamin A deficiency is associated with hepatitis C virus chronic infection and with unresponsiveness to interferon-based antiviral therapy. HEPATOLOGY 2013;57:925-933.
CORRESPONDENCE
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Nevertheless, we appreciate the suggestion, and we will take it into account for future analyses. Fourthly, we included a study5 with a reduced percentage of patients (35%) receiving vitamin D supplementation. When we excluded this report, the odds ratio value did not change significantly (odds ratio 5 0.58, 95% CI 0.32-0.99). Finally, it is noteworthy that the two meta-analyses have sought the same goal from different perspectives. Kitson et al.C ¸ s metaanalysis included seven articles and four conference abstracts, while our meta-analysis included 11 studies. Only two articles were analyzed in both meta-analyses. Both studies showed differences in the inclusion/exclusion criteria and in the analysis strategy; thus, Kitson et al. compared baseline levels of 25(OH)D, but we analyzed the data considering several thresholds frequently used to define 25(OH)D status in clinical practice. For these reasons, we consider that both studies are complementary and might be useful.
DANIEL PINEDA-TENOR, PH.D. MO´NICA GARCI´A-A´LVAREZ, PH.D. MARI´A A. JIME´NEZ-SOUSA, PH.D. AMANDA FERNA´NDEZ-RODRI´GUEZ, PH.D. SALVADOR RESINO, PH.D. Viral Infection and Immunity Unit Centro Nacional de Microbiologıa Instituto de Salud Carlos III Majadahonda, Madrid, Spain
C 2015 by the American Association for the Study of Liver Diseases. Copyright V View this article online at wileyonlinelibrary.com. DOI 10.1002/hep.27797 Potential conflict of interest: Nothing to report.
References Reply: We appreciate the interest of Kitson et al. in our recent article.1 We found an association between the cutoff of 20 ng/mL of 25-hydroxyvitamin D (25[OH]D) and sustained virologic response in patients on pegylated interferon-a/ribavirin therapy (odds ratio 5 0.53, 95% confidence interval 0.31-0.91), which is in disagreement with the meta-analysis published by Kitson et al. Thus, these authors suggested some issues that should be clarified. Firstly, Kitson et al. pointed out that our analysis included three different studies with the same Italian cohort.2-4 However, these studies were published by prestigious journals during consecutive years and provided independent and remarkable information, each of them including a different number of patients. Nevertheless, the significant association was lost if we reanalyzed it considering only one of these studies. Secondly, with regard to the studies that were not included in our meta-analysis, we carefully selected articles from PubMed, SCOPUS, LILACS, and the Cochrane Library. When data were unclear, incomplete, or not explicitly reported, we contacted the corresponding author up to three times in order to obtain additional information. Unfortunately, some authors did not reply or refused to provide the requested data. Thirdly, we only included studies in which vitamin D was assessed as a categorical variable (the thresholds for deficiency, suboptimal, and optimal 25[OH]D levels) because we considered that it was more relevant and useful than the continuous variable.
1. Garcıa-Alvarez M, Pineda-Tenor D, Jimenez-Sousa MA, FernandezRodrıguez A, Guzman-Fulgencio M, Resino S. Relationship of vitamin D status with advanced liver fibrosis and response to hepatitis C virus therapy: a meta-analysis. HEPATOLOGY 2014;60:1541-1550. 2. Bitetto D, Fattovich G, Fabris C, Ceriani E, Falleti E, Fornasiere E, et al. Complementary role of vitamin D deficiency and the interleukin28B rs12979860 C/T polymorphism in predicting antiviral response in chronic hepatitis C. HEPATOLOGY 2011;53:1118-1126. 3. Falleti E, Bitetto D, Fabris C, Fattovich G, Cussigh A, Cmet S, et al. Vitamin D binding protein gene polymorphisms and baseline vitamin D levels as predictors of antiviral response in chronic hepatitis C. HEPATOLOGY 2012;56:1641-1650. 4. Bitetto D, Bortolotti N, Falleti E, Vescovo S, Fabris C, Fattovich G, et al. Vitamin A deficiency is associated with hepatitis C virus chronic infection and with unresponsiveness to interferon-based antiviral therapy. HEPATOLOGY 2013;57:925-933. 5. Bitetto D, Fabris C, Fornasiere E, Pipan C, Fumolo E, Cussigh A, et al. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Transpl Int 2011;24:43-50.
Author names in bold designate shared co-first authorship. C 2015 by the American Association for the Study of Liver Diseases. Copyright V View this article online at wileyonlinelibrary.com. DOI 10.1002/hep.27796 Potential conflict of interest: Nothing to report.
Is Pentoxifylline Still an Option in Severe Alcoholic Hepatitis? To the Editor: We read with interest the Hepatology Elsewhere piece by Caballeria1 describing the study by Park et al. that investigated the rela-
tive efficacies of prednisolone and pentoxyfylline in acute alcoholic hepatitis in a noninferiority study.2 Caballeria states that the trial concluded that the efficacy of pentoxifylline is lower than that of prednisolone. However, the noninferiority endpoint of that study
