S2-E48 – Closing Thoughts On an Eventful NASH Summer

Mazen Noureddin joins Stephen Harrison, Louise Campbell and Roger Green to close our series of "Biggest Stories of NASH Summer" with his own unique slant on recent events and publications.

Mazen’s take on the ‘Biggest Stories of NASH Summer” integrates the content of papers, the journals in which they were published and the attention they received to form a message that says, “Fatty Liver has more good news to report and more people who want to learn about it.” Halfway through, Stephen Harrison “hijacks” the episode to ask a common sense question about how the Fatty Liver community uses slides from biopsies today. This leads to a conversation in which each participant comes at the issue from a dramatically different angle.

Highlights include:
8:49 – Mazen Noureddin begins to discuss his “Biggest Stor(ies) of Summer”
9:54 – Mazen focuses specifically on the efruxifermin (EFX) paper in Nature Medicine
12:56 – Mazen shifts focus to the recent paper from the Mayo Clinic group that used a retorspective study of MRE results and longer-term outcomes to demonstrate that MRE improve prognosis accuracy in CLD patients
15:24 – Stephen Harrison begins his response to Mazen
16:45 – Stephen discusses what he considers the most important lessons from the EFX trial
18:33 Mazen on where FGF-21s are likely to be used and what what duration
22:21 – Stephen “hijacks” the discussion to raise the idea of one H & E slide per biopsy.
25:12 – Mazen agrees with Stephen’s statement about multiple slides
26:51 – Roger concurs from a probability sampling point of view
27:18 – Louise begins her reply by discussing the impact of side effects on patients, using Hep C as an earlier example, and the hope that clinical trials can more closely resemble care in everyday practice
29:06 – Stephen comments on why trials and clinical practice are so different and why it continues to be this way
31:38 – Mazen discusses FGF-21 side effects in the context of GLP-1s
32:47 – Louise notes that biopsy samples are valuable and costly to the patient (in terms of discomfort, at least) and that we show the patient respect by extracting the maximum possible value from each tissue sample
33:31 – Roger asks the historical logical for doing only one H & E slide per patient. Mazen speculates, then Stephen explains.
37:05 – Roger asks whether the goal is to improve screen fail rates and reduce placebo scores at the same time. Stephen confirms this.
37:58 – Roger asks group to assign scores to the relative importance of multiple slides, new medications and moving to NITs. Answers vary. The reasons are even more interesting than the answers themselves

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