S4-E9.4 - Combating Swelling NAFLD and NASH Prevalence: Drugs, Diagnostics and Guidelines for the Frontline

This week, SurfingNASH is offering conversation segments to showcase our new series, The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide. Rising Tide, as we call it, is a subscription-only series targeted at the primary care physicians, endocrinologists and allied health professionals who provide front-line treatments for patients living with Type 2 Diabetes and/or obesity. This sample session comes from the just-released Season 2 debut which focuses comprehensively on a new chapter of the podcast and why 2023 might be “the best year ever” for Fatty Liver.

The group considers what made 2022 special. Mazen highlights Madrigal’s positive topline results from the Phase 3 trial of resmetirom for treatment of NASH and liver fibrosis. He also notes Intercept’s study on evaluating the safety and efficacy of obeticholic acid in patients with compensated cirrhosis. Ken underscores the development of algorithms for identifying and diagnosing patients. He is optimistic about different societies aligning to define pathways because NAFLD and NASH are metabolic diseases at the center of converging fields. Roger states his highlight of 2022 to be movement toward noninvasive tests and away from biopsies.

Conversation expands on the NASH drug pipeline. Mazen cites utility in GLP-1 medications, like semaglutide, and the pan-PPAR agonist, lanifibranor. Roger adds that efruxifermin, an FGF21, has the potential to regress fibrosis in pre-cirrhotic patients. Ken notes it was previously thought that a monotherapy would cure NASH. Today, the promise of combination therapies demonstrates benefits which positively impact weight and other cardiometabolic variables. Roger echoes the idea that the ability to stop progression and reduce steatosis is an achievable target today.

Shifting to diagnostics, Roger explains the fading narrative of biopsy as a gold standard. Mazen emphasizes need to screen Type 2 diabetics and those with two or more metabolic risk factors. He introduces a simple test, called FIB-4, which helps to estimate the amount of scarring in the liver. FIB-4 is a basic computation that factors a patient’s age, liver enzymes and platelet count. He also describes transient elastography FibroScan, a noninvasive method evaluating liver fibrosis by measurement of liver stiffness. Lastly, he details the enhanced liver fibrosis (ELF) test, a blood test that provides a score reflecting the severity of liver fibrosis. A key message: patients with Stage 2 fibrosis and higher need to be referred as this is the population with significant risk of facing severe complications. Ken builds on the idea behind criticality in screening and identifying early in disease progression. There are simply not enough hepatologists to treat the millions of patients with liver disease.

After more notes around guidelines and practical, systemic approaches to navigate widespread prevalence, the panelists offer closing comments. The final points focus on: 1) biggest takeaways for frontline treaters, and 2) most exciting elements to emerge in this space in 2023.

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The Rising Tide podcast series and all episodes are produced under a non-restricted grant from Novo Nordisk. Novo Nordisk has neither influenced nor reviewed the contents of this podcast in any way. This content represents the views of the speakers and does not necessarily represent the views of Novo Nordisk. The content herein is for educational purposes only and should not be taken as medical advice.