S2-E63 - Manal Abdelmalek, Ken Cusi And Jörn Schattenberg Join SurfingNASH's 2021 NAFLD Year-In-Review

Send us Fan MailThe last half of December marks our annual NAFLD Year-in-Review. Episodes 62-64 each include ~20 minute segments of longer interviews with Stakeholders who have made a dent in Fatty Liver disease in 2021. In this episode, Louise Campbell and Roger Green are joined by Manal Abdelmalek, Kenneth Cusi and Jörn Schattenberg.Highlights:3:26 – Manal Abdelmalek introduction and discussion: opportunities in the new drug pipeline and ways to treat using older agents until new agent arrive5:06 – 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 heterogeneity of cirrhosis patients all the time. Some day, genetics will pinpoint each patient's outcome to avoid so we can treat accordingly12:20 – 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 pathways24:10 – 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 Park27:01 – 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 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 recommendations37:03 – Louise: Fatty Liver disease has far broader implications than simply for the liver38:41 – Roger: asks how liver testing and vigilance will fit in  schedules and practices of already overburdened providers 39:55 – Ken:  requires a of simple, inexpensive, easily accessible  Stage 1 tests like FIB-4, was key to its selection42:22 – Jörn Schattenberg introduction and question: how are cost effectiveness analyses progression44:25 – 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 cost effectiveness of inaction?50:38 – Jörn: value of monitoring relies on measuring related risks from cardiovascular and other systems52:22 – 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 target1:01:09 – Episode ends