The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to preview key presentations and posters of interest.
The preceding conversation finished with Jörn discussing the proper use for FIB-4 (in referral pathways) and the improper use (in specialty practices and clinics). This conversation picks up with Jörn listing tests he prefers in his clinic: MRE and FAST. Stephen notes that many guidelines recommend FIB-4 followed by FAST. He asks, why not start with both and improve our ability to identify patients who need therapy? Roger responds by mentioning a poster from Mayo Clinic (#2309, Performance of AGA Clinical Care Pathway for the Risk Stratification of Patients with NAFLD in the US population). The poster suggests defining the AGA guidelines so that only patients with Type 2 diabetes and FIB-4 >1.3 would reduce the number of scans by almost 10 million, or 70% of demand. This would not significantly affect how many patients are missed. The group agrees this is a good approach in specialty practices, but probably not easy to implement or cost-effective in primary care.
Jörn shifts focus to Daniel Huang’s presentation at Sunday’s Presidential Plenary session. The presentation compares fibrosis progression rates for diabetic vs. non-diabetic patients with biopsy-proven NAFLD. He notes two key findings of interest: First, while it has always been assumed that fibrosis progresses one level in seven years, the number for patients with diabetes may be closer to one level every six years. Second, the cumulative progression over the entire populations in a 12-year period was 93% for patients with diabetes and 76% for patients without diabetes. Jörn notes this to be a significant difference in patient numbers, highlighting an urgent need for treatment in the diabetic population.