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. In this preview, Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest.
Earlier this month, Stephen and Jörn joined Roger, Louise Campbell and Mazen Noureddin to review a string of recent press releases on NASH drug development. Many of these are AASLD late-breakers. Today’s podcast covers presentations and posters not discussed previously.
Stephen begins by mentioning an analysis Rohit Loomba will present from MAESTRO-NASH results, a 2,000-patient Phase 3 trial. This analysis demonstrated that FIB-4 with a cutoff of 1.3 failed to identify 57% of F2 patients, 40% of F3 and 26% of F4. To Stephen, this says if we rely solely on FIB-4, “we’re probably leaving behind a lot of patients that should be treated.” He suggests adding VCTE to FIB-4 to improve precision in screening these patients.
Jörn and Roger have a common reaction: FIB-4 is not a tool for the specialist’s office but, instead for primary care practices conducting first-line screening. Jörn states that the guideline referrals for FIB-4 use apply specifically to primary care and that in his clinic, he would never evaluate a patient solely based on FIB-4. Roger comments about a large number of papers at the conference seeking to improve efficiency and reduce cost of front-line screening, not to add literally millions of VCTE tests per year to primary care schedules and budgets. Jörn closes the discussion by saying that the common message to the field today is that FIB-4 is an important primary care tool, but it is far from perfect and we should seek better options over time.
Jörn focuses on Dr. Daniel Huang’s presentation at Sunday’s Presidential Plenary session comparing fibrosis progression rates for diabetic vs. non-diabetic patients with biopsy-proven NAFLD. He notes that while conventional wisdom is that NASH progresses by one stage of fibrosis every seven years, the rate for diabetic patients in this study is reported to be one stage every six years. This leads to a broader discussion about screening and treatment for patients with diabetes, where the emerging consensus is to assume NAFLD and screen for NASH and fibrosis.
Jeff McIntyre focuses on patient issues by discussing Donna Cryer’s “Health Equity” talk on Saturday morning. Jeff suggests we all think of health equity in context of stigma, access and policy barriers, these are broader than simple equity issues. “Access,” he notes, can refer to how adoption of NITs in clinical trial programs will make trials practical for a larger number of patients. “Stigma” refers not only to the stigma of liver disease, but also to whether stigmatized groups such as the obese or people living with HIV get care sensitive to their needs. To that end, he points specifically to a session at 10:30a Saturday morning called “Liver and Queer,” an introduction to the AASLD LGBTQ task force. This bridges into discussions about obesity and its global implications, one of which is that Fatty Liver leads to HCC and other cancers…and from there to ways to draw attention to the need to treat Fatty Liver, which Stephen describes as the “canary in the metabolic dysregulation coal mine.”
As time winds down, Roger briefly references a couple of posters that take innovative looks at how to create inexpensive, widely available screening through tests and/or analysis of medical records. He invites everyone back next week to discuss some more of the presentations and this data-rich, insight-laden conference.