During the last half of December, Surfing the NASH Tsunami is devoting itself to a NAFLD 2021 Year-in-Review. Episodes 62-64 each include ~20-minute segments of three longer interviews with Stakeholders who have made a dent in Fatty Liver disease in 2021.
In Episode 63, Louise Campbell and Roger Green discuss the use of older and newer drugs with Dr. Manal Abdelmalek, Director of the NAFLD Clinical Research Program at Duke University, Creating a multi-specialty call to action and clinical care pathways with Professor Kenneth Cusi of the University of Florida, and balancing cost-effective care with patient needs and quality of life with Professor Jörn Schattenberg of the University of Mainz.
Final timestamps for E63
3:26 – Manal Abdelmalek introduction and discussion: opportunities in the new drug pipeline and ways to treat using older agents until new agent arrive
5:06 – Manal: urgent to treat cirrhosis when it appears. Reversal may not be “achievable;” but blunting progression can provide stability
9:51 – We learn more about the heterogeneity of cirrhosis patients all the time. Some day, genetics will pinpoint each patient’s outcome to avoid so we can treat accordingly
12:20 – Louise: would a combined database of multiple cirrhosis drug study patients provide richer insights?
14:05 – Manal: let’s “shelf,” not “trash,” drugs that had promising NIT results but missed in Phase 2b or 3 histology
18:57 – Louise: Manal does well to remind us how to use older drugs to stabilize cirrhosis patients.
21:05 – Manal: until new drugs become commercially available in 2-5 years, using older drugs better will be key
23:07 – Ken Cusi introduction and discussion: development of multi-disciplinary activities and clinical care pathways
24:10 – Ken: New data on prevalence and etiology of NASH cirrhosis spurred multi-specialty activities
24:41 – Key insight drivers: NHANES analyses, endorsements from medical societies and global journals, work of Jeff Lazarus and Wilton Park
27:01 – 2022 a “great year:” new/updated guidelines, major Phase 3 trials progressing
30:00 – Louise: AGA critical care pathway work and collaboration among specialties pivotal, positive and extending to related consumer industries
31:26 – Ken: 2-3 years from now, foresees “convergence of awareness” to expand FIB-4 and other simple tests to more patient risk subgroups.
33:25 – Study in progress: screening a large number of patients to determine NASH prevalence among non-diabetic patients
35:34 – There was significant debate whether to include screening for T2D patients in the 2018 AASLD guideline recommendations
37:03 – Louise: Fatty Liver disease has far broader implications than simply for the liver
38:41 – Roger: asks how liver testing and vigilance will fit in schedules and practices of already overburdened providers
39:55 – Ken: requires a simple, inexpensive, easily accessible Stage 1 tests like FIB-4, was key to its selection
42:22 – Jörn Schattenberg introduction and question: how are cost-effectiveness analyses progression
44:25 – Jörn: 2021 has been “an exceptional year” for NASH
46:04 – Collaborated with Vlad Ratziu and others to produce cost of illness study published in Liver International in 2021
49:39 –Louise: why does it feel like we study cost-effectiveness only for expensive new drugs and never measure the cost-effectiveness of inaction?
50:38 – Jörn: the value of monitoring relies on measuring related risks from cardiovascular and other systems
52:22 – Roger: re Louise’s question, most cost-effectiveness work evaluates a specific new expenditure, not a global “what if”
55:44 – Jörn: quality-of-life, which has clear economic costs, strongly associated with NAFLD
57:14 – Roger: Using HER to identify patients at risk might be a more palatable way to target education and information
59:50 – Jörn: An Optum database algorithm built by NIDDK provides a look at how to target
1:01:09 – Episode ends