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Sven Francque begins this conversation by discussing Laurent Castera’s paper comparing a range of NIT diagnostic tests: MAST, FAST, MEFIB, FIB-4 and NFS. When introducing the paper, Sven shares two items that Mazen Noureddin did not cover in an earlier preview. Professor Castera and his team used fairly low ALT cutoffs of 20 for women and 30 for men as the sole liver entry criterion for the study. The implication of this was to produce a relatively unbiased population sample in which more than 50% of patients exhibited NASH. Stephen Harrison joins to share data from his presentation on the FASN inhibitor that Scott Friedman referred to in the first review episode. Stephen describes that AI-based percent collagen computations in the FASN study indicated its highest correlation was with the FAST score. Additionally, MAST was comparable and AST alone holds significant power.

Roger Green looks to broaden the conversation by asking what we have learned about tests in this meeting. Ian Rowe summarizes the message he has derived from a range of studies to link the screening target - fibrosis vs. advanced fibrosis - with the value of a two-step testing strategy. As both Stephen and Mazen have suggested on recent episodes, Ian considers a compelling argument for moving straight to FAST. Roger expands that, as Professor Castera pointed out, the low gray zone number on the MAST test promises a far higher level of true positive and true negative results. It also promises significant cost savings in terms of reduced biopsy demand when screening for clinical trials. Ian builds on these considerations to make a final statement as this session winds down. If we have drugs available to treat patients in the community, providers need to become far clearer about diagnostic goals and then find the right test to link to each goal.