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S2-E63.2 – SurfingNASH’s 2021 NAFLD year-in-review Covers NASH Multidisciplinary Initiatives and the Clinical Care Pathways Paper

This conversation is part of SurfingNASH’s 2021 NAFLD Year-In-Review. Professor Kenneth Cusi of the University of Florida joins Louise Campbell and Roger Green to discuss the NASH multidisciplinary initiative organized under the aegis of AGA the resulting paper of Clinical Care Pathways.

In 2021, Ken Cusi played an integral role in the NASH Multidisciplinary initiative fostered under the aegis of the American Gastroenterological Association (AGA) and leading to the paper “Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease,” originally published in “Gastroenterology”.

This conversation begins with Ken mentioning some of the motivations and sources that led to the creation of the multidisciplinary group behind the Clinical Care Pathway paper and the earlier “Preparing for the NASH Epidemic: A Call to Action.” Ken starts this conversation by discussing the momentum that is building around taking a disciplined, multidisciplinary approach to the emerging NASH pandemic.

He cites recent US publications based on the NHANES database and work done in Europe by Jeff Lazarus and Wilton Park as being major driving forces. The discussion moves on to Ken’s prediction that 2022 will be a “great year” based on new or updated guidelines from AASLD, AACE and the American Diabetes Association plus Phase 3 studies coming forward for semaglutide, lanifibranor and resmetirom. Louise Campbell notes that not only are medical groups collaborating, but in the UK, food companies have requested more robust food labeling guidelines from the government there.

Ken goes on to predict “a convergence of awareness” around the clinical care pathway and using FIB-4 as a first stage test. He notes that ELF and ProC3 will become commercially available, which will augment testing capabilities and goes on to discuss some larger studies taking place to better define risk for different elements of the population. Louise Campbell asks what is likely to change over the next 2-3 years, at which point Ken discusses the increasing momentum he believes will lead to more testing, increased data generation and studies and a broader awareness of the role the liver plays in overall metabolic health. Roger asks how the new testing and patient vigilance will fit into an already overcrowded patient visit workload.

Ken suggests that placing FIB-4 results and guidance on electronic medical records will increase primary care awareness and action by itself. This energy is offset somewhat by a lack of compensation for primary care and endocrinologists who identify patients with cirrhosis and also by the emotional exhaustion of treating patients through the COVID-19 pandemic. From here, the group goes on to discuss the processes through which screening and diagnosis are likely to become more widespread and treatment will become better integrated. In the end, Ken discusses the reasons he is highly optimistic about where the entire NASH field is heading in the years to come.

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