S5 - E9 - Value of VCTE Or Other In-Office MASLD Monitoring

Surfing the MASH Tsunami

Hannes Hagstrom joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss recent research panelists have conducted. This content-dense conversation focuses initially on the impact of VCTE and other forms of in-office monitoring and branches out from there.
00:00:00 - Surf's Up: Season 5 Episode 9
Opening comments from the panel, including brief quotes taken directly from the episode.
00:02:04 - Introduction and groundbreaker
Each panelist shares one piece of good news from the previous week.
00:06:02 - Introducing Topic
Roger invites panelists to share research they either participated in over the past couple of months or found particularly important.
00:06:57 - VCTE scores predict liver-related events as well as or better than biopsy
Hannes discusses a recent paper in which he participated (Vibration-Controlled Transient Elastography Scores to Predict Liver-Related Events in Steatotic Liver Disease; H. Lin et al., JAMA Online, 21MAR 2024.) This paper suggests that, in Hannes's words, "[VCTE] may be enough if you want to predict the risk of outcomes."
00:09:41 - The value of repeat measures
Panelists comment on the value and discrete benefits of taking frequent repeat measures for in-office scanning tests.
00:12:15 Changing gluten vs. reducing sugar: impact for patients
Louise mentions a recent study by Armandi et al. looking at the impact of changing gluten content on MASLD. The group discusses the benefits of offering patients multiple behavioral options.
00:20:33 Impact of increased access to in-office scanning
Roger asks whether an increased focus on overall in-office scanning may speed the replacement of biopsy with scan results in clinical trials, at least in the U.S. Panelists describe other possible benefits.
00:23:48 LiverAIM
Jörn discusses the LiverAIM consortium and its goal to improve that testing improves outcomes. The group asks whether prognostic value can provide a rationale for broader screening. Jörn suggests that LiverAIM might answer some of these questions.
00:28:56 Primary care as triage
Roger focuses the discussion on how various healthcare systems will manage the tsunami of patients likely to come to physicians' offices once a drug is available and patients are aware. Hannes describes a role for primary care that Roger describes as "triage."
00:31:05 Is VCTE a simple enough solution?
Roger asks whether VCTE can become the easy-to-interpret test that motivates primary care to engage. Jörn suggests we will need a simpler, potentially automated algorithm, possibly something like the Fibrotic NASH Index ("FIB-4 on steroids").
00:37:30 Predictive biomarkers and commercial success
Hannes notes that we will need a way to determine whether a given drug works for a particular patient. To Jörn, this raises the general question of predictive biomarkers for individual drugs or drug classes., which the group agrees will take years to sort out.
00:41:19 Diet and exercise
Louise suggests that the label statement that Rezdiffra is adjunctive to diet and exercise will require prescribers to monitor the efficacy of lifestyle intervention. Jörn and Roger note that this is standard in the U.S. language and requires little real monitoring.
00:44:20 - Closing question
Roger asks each panelist what we might achieve over the next two years to improve our ability to get the right patients to therapy.
00:49:15 - Question of the Week
The question asks what role you envision office scanning techniques like VCTE and 3D ultrasound playing in the future of patient screening and the development of clinical care pathways compared to computed tests.
00:50:04 - Business report
This week's news on audience metrics, our upcoming 4th anniversary and this week's Vault conversation.