In this presentation, we reviewed the key changes in the new nomenclature for MASLD and discussed the definition of MASLD and MASH. Following this, we reviewed the AASLD practice guidance regarding the non-invasive tests that can be used to risk stratify patients with MASLD into low, intermediate or high risk for advanced fibrosis using FIB-4 followed by either liver stiffness assessment by vibration controlled transient elastography (VCTE) or magnetic resonance elastography (MRE) or blood based biomarkers such as enhanced liver fibrosis panel (ELF). We also discussed the clinical utility of liver fat quantification and decline in liver fat as a predictor of histologic response.
Key issues in the management of MASH including role of weight loss, exercise and reducing alcohol intake was also discussed, as well as data regarding therapies in phase 3 clinical trials. Resolution of MASH and regression of fibrosis by 1 stage is considered clinically meaningful improvement in MASH. Data regarding resmetirom, a thyroid beta receptor agonist, and GLP- analogues such as Semaglutide and trizepatide, and FGF-21 analogues such as effruxifermin and Pegozafermin, are also reviewed. Resmetirom is now FDA approved for the treatment of MASH related moderate and advanced fibrosis without cirrhosis. Several therapies have shown promise in both mash resolution and fibrosis regression in MASH.
Biographies
Dr Rohit Loomba
Dr Rohit Loomba is a Professor of Medicine (with tenure), Chief, Division of Gastroenterology and Hepatology, at the University of California at San Diego. He is an internationally recognized thought leader in translational research and innovative clinical trial design in nonalcoholic steatohepatitis (NASH), and non-invasive assessment of liver disease using advanced imaging modalities.
Dr Loomba is the founding director of the UCSD MASLD Research Center, which fosters collaborative team science where a multi-disciplinary team of researchers are conducting cutting edge research in all aspects of NAFLD including non-invasive biomarkers, genetics, epidemiology, clinical trial design, imaging end-points, and integrated OMICs using microbiome, metabolome and lipidome. This integrated approach has led to several innovative applications such as establishment of MRI-PDFF as a non-invasive biomarker of treatment response in early phase trials in NASH, which has now been adopted in more than 100 clinical trials conducted worldwide. He holds several patents on non-invasive biomarkers of NASH and fibrosis.
His research is funded by the National Institutes of Health as a Principal Investigator including two R01s, three U01 (two NIDDK and one from NIAAA), clinical core director of P30 (NIDDK) and project director P01 (NHLBI) grant mechanisms, Foundation of NIH, as well as several large multicenter, multi-million dollar investigator initiated research projects funded by the industry. He is the Principal Investigator, UCSD, for the NIDDK-sponsored NASH Clinical Research Network and the Liver Cirrhosis Network. He also serves as on the Scientific Advisory Board of numerous biotechnology and large pharmaceutical companies and guides clinical drug development and biomarker discovery programs globally.
He serves on the Editorial Board of Gastroenterology, Journal of Hepatology, GUT and Nature Reviews in Gastroenterology and Hepatology. He recently completed a 5-year term as the Deputy Editor of HEPATOLOGY, the official journal of the AASLD. Currently, he serves as the co-Editor of Alimentary Pharmacology and Therapeutics, an international journal in the field of gastroenterology and Hepatology. Dr Loomba has published more than 500 manuscripts and has an H-index of 152. He has been consistently listed among the top 1% of the globally highly cited scientists across all fields since 2019 by Web of Science. He is an elected member of the American Society of Clinical Investigation (ASCI), and the Association of American Physicians (AAP).
Dr Sophia Than
Dr Sophia Than is a consultant hepatologist working at the University Hospital Coventry NHS Trust. Her area of interest is managing patients with decompensated liver cirrhosis, metabolic dysfunction-associated steatotic liver disease and hepatocellular carcinoma.