S3-E33 - Day 4 of ILC2022: Friendly Debates About NITs, PLUS Discussing the Patient Advocate's Perspective

The International Liver Congress (#ILC2022) is the first major hepatology Congress to be held in person since the start of the pandemic (smaller, but very valuable, meetings like NASH-TAG, LiverCONNECT and Paris NASH have taken place with an in-person component, but the International Liver Congress and The Liver Meeting have not).

The conversation takes place against the schedule of a live Congress on the day that focused on drug development. This presented scheduling challenges, which Louise Campbell addressed by combining two shorter conversations.

The first conversation included Jörn Schattenberg, Mazen Noureddin and Ian Rowe and focused on a morning session titled "NAFLD: Diagnostics and non-invasive assessment." This conversation focused on several elements of this session: papers demonstrating the relative lessons and values of FAST, MAST and MEFIB, an analysis from the LITMUS Metacohort identifying the combination of metrics that did the best jobs of specifically predicting fibrosis, steatosis, ballooning and inflammation, and papers looking at the ability of FIB-4 to identify at-risk patients. The most important conclusions: (i) the LITMUS presentation attempted to correlate to biopsy, which is a suboptimal target; researchers should consider the limitations of biopsy in planning future trials; and (ii) many tests have significant value as long as we use them properly with an appreciation of what the test seeks to determine and why for that purpose, one test might be better or weaker than others.

As this conversation winds down, Louise Campbell discusses interpretive challenges caused by the fact that studies do not list the generations of technology researchers use. She points out specifically that successive generations of FibroScan demonstrate significant differences in terms of tools that are available and the reliability of different tools. 

Finally, Jörn discusses a study in the Public Health session from the SEAL program suggesting that roughly half the patients never return for their second visits. After this, Mazen asks Jörn to discuss his presentation in the NAFLD Diagnostics session. Jörn presented results of a MAESTRO-NASH analysis in which the researchers assessed the ability of FIB-4 to identify and diagnose at-risk F2 and F3 patients from among a 2,000 patient cohort. Key point: 37% of patients in this trial had normal ALT and 80% had <2x normal ALT. The second finding was that FIB-4 with a cutoff of 1.3 will miss a significant number of at-risk patients defined by F2 and F3. In this session, Jerome Boursier presented a study with a similar finding for diabetic patients. Louise mentioned a presentation from Rohit Loomba that made similar points with cirrhotic patients. 

With this, the episode shifts to Louise's interview with Robert Mitchell-Thain, CEO of the PBC Foundation and long-time patient advocate with The Global Liver Institute. Robert commends the "really holistic, complete" agenda that, from a patient perspective, "really sets the standard of where we need to go in the future." He advocates bringing more patient perspectives into symposia and other events and programs. In response to Louise, Robert highlights several items that "rocked his world": the number of patients whose disease is missed when we rely on a FIB-4 test as the sole screening tool; the importance of bringing patients into the disease discussion early in the course of the disease. From here Louise and Robert go on to discuss the roles of doctors, nurses, other professionals and patients in maintaining an open discussion of the real-world challenges of therapy. They focus on two pertinent, realistic challenges: sexual dysfunction and physical appearance. Words cannot do this conversation justice...you will simply have to listen.