S4-E40.3 - Which test is best for which patients?

Send us Fan MailAlong with NASH-TAG, Paris NASH is one of two famously small, science-based and publicly available events every year for the liver community. Given the depth of topics and ideas explored in Paris, the event in its entirety would be nearly impossible to cover in a single conclusive episode. That said, the Surfers (Jörn Schattenberg, Louise Campbell and Roger Green) are joined by two presenting KOLs, Scott Friedman and Laurent Castera, for a neatly packaged conversation to capture some of the key dynamics of the meeting. Particularly, the group hone in on developments in the landscape around NITs.This conversation begins with Jörn discussing his topic from Paris NASH. His notes stem from a topic he received from the organizers: once a drug is available in the clinic, which test will you use to decide if the patient gets the drug. Jörn notes quickly that he will use neither biopsy nor FIB-4. He then notes that FAST was designed for this purpose, but that no current test makes sense today. Scott raises the parallel question: once you commit a patient to therapy, how will you determine whether the patient is responding or not? Jörn notes that most of the data we see today is aggregate, rather than the individual patient data we will need to assess how each patient performs on these tests. Laurent notes that there is not much data on this issue and then goes on to discuss the one study that does exist. He also describes a two-stage decline in test scores over time, with a more robust early decline and a slower decline later. That said, he questions whether the reduction in stiffness results from a decline in inflammation or fibrosis. As the conversation winds down the floor goes back to Scott and Jörn. Scott notes that while the question is interesting, declines in inflammation or fibrosis both correlate with improved outcomes. He also notes that currently developing fibrosis-specific markers like ProC3 may help answer this question. Jörn says that the answer he gave in the meeting is a form of “it depends” – in this case, possibly on the starting level of drug, whether the decline is early or late stage and the starting fibrosis level.This episode and its conversations cover a range of fascinating insights stemming from yet another impactful Paris NASH meeting. If you have questions or comments around Paris NASH, NITs or any other themes addressed, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected] Safe and Surf On!