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NASH-TAG 2023 proved to be a watershed moment for Fatty Liver disease as exciting drug development readouts, powerful academic work on non-invasive tests and the willingness to dive into the toughest questions aligned in Deer Valley, Utah. In this weekend’s conversation series, Surfing NASH reviews its diverse coverage of the conference by showcasing key excerpts across six recordings with various KOLs, patient advocates and stakeholders.

This conversation includes analysis by Scott Friedman, Rachel Zayas, Jörn Schattenberg, Louise Campbell and Roger Green. Roger leads by asking the group to detail the “sit up and take notice” moment of the meeting. Scott immediately describes the “800-lb gorilla in the room,” the resmetirom data, which casts a positive light around everything within the meeting at large. He goes on to discuss other key points, namely, compelling results for other drugs in earlier stage trials and NITs. Rachel agrees with Scott, stating that “the narrative has changed.” She also mentions Mary Rinella’s nomenclature talk and the discussion of combination therapies. Jörn praises the high energy level and well-rounded nature of the talks. Louise points to previously unpublished efruxifermin data from the HARMONY trial that suggested to her we can place drugs in primary care practices if we also ensure they have appropriate tools and tests to monitor patients.

Scott underscores perhaps the most staggering number in the meeting: only 3% of patients treated for NASH are treated by a hepatologist. Jörn concurs with this observation, adding that this casts light on the importance of using the NITs at hand to identify patients. Scott then referred back to Will Alazawi’s presentation on pathways and a brief presentation from Siemens evaluating four different test strategies in terms of lowest cost and highest prediction. Roger comments that the wealth of NIT data is actually starting to point to simple strategies for using them in clinical trials and treating patients. The uses may vary, but the paths seem clear. For Roger, Fagan’s nomogram, which Mike Charlton presented, was the moment at which the paths became clear. He next asks Scott to describe what he considers most pivotal here. Scott goes on to discuss the need to identify non-responders better and figure out how to best manage them. Jörn agrees in the profundity of this analysis and, in that context, calls into question whether our definition of “response” might change from fibrosis regression to something more broadly metabolic. As the talk winds down, Louise notes that we have seen some promising data about combination therapies. Lastly, Scott notes that we have far more scientific ways to approach combination therapy than simply seeing what drugs a company has in its portfolio.