S3-E47 – What does the next year hold for the NAFLD metabolic disease link?

S3-E47 - What does the next year hold for the NAFLD metabolic disease link?
Surfers Roger Green, Jörn Schattenberg and Louise Campbell embark on their first exclusive discussion together in a while without any guest panelists. After several weeks of attending and reviewing conferences, the trio take the opportunity to talk about what the next year holds for the NAFLD-metabolic disease link.

The last month has witnessed several major Fatty Liver conferences and others that touch on NAFLD in the context of metabolic disease. One common theme has been the need for different specialties to align in treating the complete range of non-communicable metabolic diseases. In this episode, Roger Green, Jörn Schattenberg and Louise Campbell propose factors that have the potential to dramatically shift the force around fatty liver disease over the next six months.

What does the next year hold for the NAFLD metabolic disease link?

Jörn starts the conversation with a personal example of a larger trend: he attended last month’s EASD meeting for the first time. Historically, few hepatologists attend this meeting, but Jörn believes his attendance is indicative of a trend: hepatologists and endocrinologists working together on diabetes and NAFLD. Louise echoes the sentiment that liver health is gaining traction as a critical function of holistic patient management, although cardiology appears to be slow on the uptake.

Roger links this collaborative energy to a completely different kind of energy formation: capital investment. He notes Akero’s recent filing for $230 million in equity to help bring efruifermin to market based on Phase 2b results. If this effort succeeds, Roger suggests that it may signify that the financial markets are becoming more optimistic about NASH drugs after several years of extreme skepticism.

Next, Jörn returns to his original theme to discuss how endocrinologists have received the concept of liver disease as part of multimorbidity management in patients living with T2DM. He reports that endocrinologists have been enthusiastic about the idea and eager to learn the liver testing tools and metrics they should use.
The group then responds to the AACE guidelines promoted last May. The guidelines recommend that front-line physicians not screen their T2DM patients for NAFLD, since 80+% will test positive. Instead, guidelines recommend using a FIB-4 test to identify patients at risk due to current fibrosis. Roger asks whether these will move into actual practice. Louise and Jörn each state that in their countries, front-line treaters are not required to perform liver enzyme blood work. These tests are pivotal for early liver screening. Louise doubts that change will come until after an expensive drug is approved, at which point there will be economic motivation to test. Jörn is more hopeful that with simple tests, he and other hepatologists can educate endocrinologist colleagues on the reasons to adopt this testing strategy over time.

The conversation shifts to speculation as to whether prescribers or payers will be the source of bottleneck in patient care pathways at the outset of a drug approval. The group generally agrees that pushback will come from the payers and that healthcare systems are not yet ready. They then look towards the social and political will to take action on the crisis. In response to Roger’s question, the group acknowledges the immense hurdles present in changing provider behavior over the next 6-12 months while stressing the importance of provider education and patient empowerment.

Finally, the group discusses the future of the recently coined “combo-combo world,” where correct diagnosis will require a combination of biomarker tests and treatment may require a combination of therapies. At the end, Roger asks what changes each member envisions. Surf on to find out.

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