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S3-E30 – Previewing #ILC2022: Focus on NITs and Patients

Jörn Schattenberg, Stephen Harrison, Louise Campbell and Roger Green discuss some of the most striking and important Fatty Liver-related abstracts to be presented at next week's #ILC2022 meeting in London. Some key drug development papers are embargoed, but there were plenty of important works on NITs, quality-of-life and general patient issues for the group to discuss.

This week, NASH Tsunami identifies some of the most important and intriguing presentations at next week’s International Liver Congress (#ILC2022) meeting, many of which focus on NITs and patient issues, including quality of life (QoL). The group was free to discuss any presentation not under embargo, which precluded several major drug development presentations. Here are the presentations and posters that the Surfers identified:

OS097: Machine learning algorithms identify novel biomarker combinations for NAFLD. Jörn raised this paper first based on the robustness of data and interesting approach. The dataset comes from 720 patients in the LITMUS Metacohort with biopsy-proven NAFLD. The researchers used 33 variables to build separate predictive models for advanced fibrosis (F>=3) and NAS (NAS>=4). The advanced fibrosis model was robust; its strongest predictors were liver stiffness (measured by VCTE) and CK-18 M30 antigen. The authors described the NAS model and various NAS element scores as “less impressive,” with different predictors for each element. Jörn praised the poster’s granularity, which allowed separate looks at each predictor.

FRI094 — Clinical and economic evaluation of community-based preventative screening strategies for NAFLD in people with Type-2 diabetes melllitus. Louise raised this paper as a “model of what might happen” when we broaden community screening to all Type 2 diabetes patients. While there were challenges to some study definitions, Louise noted that testing proved cost-effective virtually no matter how data were analyzed.

FRI100 — Shear wave elastography, transient elastography and enhanced liver fibrosis test use in the assessment of NAFLD in real-world practices. Louise discussed this paper briefly to note that in a fairly large “real-world” population, FIB-4 plus shear wave elastography and VCTE provided sufficient data for a viable assessment of high-risk populations.

OS044 NAFLD patients have worse health-related QoL compared to the general population irrespective of their fibrosis stage: results from a prospective multicenter UK study. Roger identified this presentation as making a vital point about QoL metrics in NAFLD. There were significant QoL differences between cirrhotics and other NAFLD patients, and between pre-cirrhotic NAFLD patients and their matched controls, but not between NAFLD and pre-cirrhotic NASH. Jörn and Roger made follow-up points dealing, respectively, with drug trial design and possible increases in forecasters’ market size estimates.

THU051 — Health-related QoL is impaired in people living with HIV and hepatic steatosis. Jörn noted that this poster from his group in Maïnz makes similar points about NAFLD and quality of life, but in an HIV population. In this group, steatosis drove lower scores for mobility, pain and discomfort. Stephen notes that the common message of the two papers is that we need to find a way for providers to discuss/query patients about quality of life in their already overloaded patient visits.

OS025 Non-invasive fibrosis scores as prognostic biomarkers of liver events, cardiovascular events and all-cause mortality in people with obesity and/or type 2 diabetes in the UK: a longitudinal cohort study. This paper, which Stephen found “quite interesting,” focuses on FIB-4 scores (classified as low, indeterminate, or high) in a cohort of 45,000, with 10 years of follow-up. High scores uniquely predicted liver events, while high and indeterminate scores both predicted CVD. For all-cause mortality, the three categories were spaced evenly. This study makes the real-world value of FIB-4, which can be hard to interpret when compared to biopsy, much clearer.

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