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In this conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi explain how the guidelines process benefitted from the close collaboration between EASL, EASD, and EASO.  

The conversation starts with Elisabetta conveying the "big advantage" that came from this collaboration. The presence of the three organizations conveyed the need to create a common way to manage patients with MASLD, many of whom live with diabetes and obesity. The guideline also used the new nomenclature, which highlighted the metabolic root of the disease.

Frank notes that the three societies have their own approval processes, which led to increased rigor from having to meet three standards. He concurs that the collaboration and approach strengthened the guidelines by putting the liver in the broader context on the disease.

After co-host Roger Green notes how much more complete this is than the previously released clinical care pathway documents, co-host Louise Campbell asks whether the guidelines will increase the profile of liver disease in other specialties. Elisabetta refers to Ken Cusi's view that "it takes time," but points out two reasons for this integration to be smoother: (i) "you can't hide cirrhosis" and (ii) diabetes and other components of the general metabolic syndrome are pivotal risk factors not only for cirrhosis, but also HCC.

Frank had been concerned at first that the name change would "lose the other societies," but the reverse was true: putting "metabolic dysfunction into the center of disease definition" links overall cardiometabolic risk to liver disease. Further, the guideline has a chapter on prevention and case-finding strategies that are relevant to primary care and diabbetology or endocrinology practices.

Earlier in the episode, Louise commended the guideline for including resmetirom even before its approval in Europe. Frank thanks her, and notes that the decision to add resmetirom came after US approval and was included within the month before the guidelines were released, similar to discussion of how some glucose-lowering drugs could help treat cardiometabolic comorbidities.