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The 2022 NAFLD Summit presented a range of perspectives and insights on fatty liver and metabolic diseases. In this episode, program speakers Mazen Noureddin, Sven Francque and Hannes Hagström join Surfer, Roger Green, on site from Dublin to review their thoughts and key takeaways immediately after the conference ended. Roger starts by asking each to choose and elaborate on one presentation or session of particular interest. Hannes is the first responder, establishing Session 7 from Day 2 as an attractive line of topic covering overlooked issues in clinical trials. While difficult to quantify the impact on clinical trials, the data supports approximately 10% of patients with NAFLD underreport alcohol consumption. Hannes’ own presentation was tied to this subject. However, his concern lies in possible patient reluctance to enter a clinical trial in response to ‘the elephant in the room.’ Roger and Mazen commend Hannes on the presentation, noting the optimism that simpler, faster biomarkers lend to the matter. Mazen extends commendations to Sven also, for his introduction and exploration of cardiovascular comorbidities within the same theme of Session 7. 

Next, Sven introduces his interest in two sessions from Friday afternoon. Specifically, he contemplates the strengths of consulting with non-hepatologists on how the treatment of comorbidities affects NAFLD. Moreover, some of those participating endocrinologists, bariatricians and other specialists possess long-standing expertise in metabolic diseases, but not necessarily NASH. They provide more holistic perspectives than one typically hears in a hepatology-centric event. As the group notes, patients rarely face NAFLD or NASH as an isolated liver problem. More often, other metabolic diseases ride along with it.

The conversation continues to highlight what differentiates NAFLD Summit from other major liver meetings. Mazen states that both the NAFLD Summit and NASH-TAG allow for a deeper dive into more provocative discussions around how to advance the field. Then, Hannes proposes the group consider stability of fibrosis worthy of investigation as an outcome. Mazen replies that preventing decompensation and associated outcomes can serve as a goal that makes fast Phase 3 cirrhosis trials possible.

Next, the group assesses Session 9 from Friday, a series of case studies on why trials fail. The panel agrees that the presentations on three failed Phase 3 trials were richly valuable and that each offered its own clear lessons for researchers.

Following, the group examines weight change and lifestyle modification, referencing insights from the obesity and diabetes fields. Roger plays the role of Louise, elucidating the immediate impact FibroScan has on illustrating results and influencing patient motivation. Improvements in patient management do have a role in contributing to better outcomes. On the other hand, there is also the pressure of minimizing placebo rates in trials. Mazen is confident in the existing data and analyses that set precedent for placebo response rates. 

Finally, Roger calls attention to a debate around NITs that took place on the opening day. Mazen Noureddin revisits what he has described on this podcast as the coming “combo-combo” world. However, Sven utters a word of caution: it is still important to evaluate the limitations of NITs. The episode concludes with a round of final reflections. Tune in and surf on for the full review.

This episode is sponsored by Resoundant, a Mayo Clinic company and the developers of Magnetic Resonance Elastography. MRE is widely available with over 2000 locations worldwide, and can be done as a low-cost, rapid exam in just 5 minutes. Together with PDFF, this quantitative exam is called an Hepatogram – a powerful non-invasive alternative to liver biopsy in many cases. For more informa