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In 2024, the two major areas for change in diagnosing and treating MASH  are new drug approval and changes in use of NITs. Naim Alkhouri and Ian Rowe join Jörn Schattenberg, Louise Campbell and Roger Green to consider what might change with NITs and how having an approved drug might change thinking on this issue.

00:00:00 - Surf's Up: Season 5 Episode 5
Opening introduction, including brief quotes taken directly from the episode discussion.

00:02:36 - Introduction and Groundbreaker
Panelists congratulate Naim on the recent, highly successful Desert Liver Conference. In the groundbreaker, each panelist shares one piece of good news from the previous week.

00:06:36 - Why Focus on NITs?
Roger describes why he considers this issue worthy of an episode. Naim and Jörn both state that they have received no referrals from PCPs or endocrinology based on elevated FIB-4 tests. Ian notes that the UK has guidelines and pathways built into some protocols; these make it challenging to stage a patient as F2 vs F3 vs early compensated cirrhosis.

00:13:06 - NITs and treating F2/3 MASH patients 
Ian says that current tools are incapable of defining the small initial target patient population Jeff McIntyre suggested in Season 5 Episode 2.  patients clearly enough to place them in a narrow diagnostic or therapeutic window. Jörn takes a "pragmatic" approach to defining the patient he is certain to treat; test results are a small part of his calculus. Naim shifts the target patient to focus on VCTE cutoff points for cirrhosis. There is no clear cutoff.

00:18:45 - Tests worth using beyond the widely discussed options
Asking, "What can we do besides scan?" or use conventional tests, Naim discusses some of the new blood-based tests. Jörn describes factors that can render a test inappropriate for a particular patient. Louise suggests the right test will depend on the specific question the provider is trying to answer.

00:22:59 - Improving on FIB-4
Roger notes that recent papers discuss failure to predict accurately with FIB-4. In the conversation that follows, panelists agree that automating test results and using a series of tests instead of a single event will both have real value.

00:28:27 - New Devices and Blood-Based Tests for Use in Office
Roger asks about new tests on the horizon and specifically whether there is sufficient improvement in diagnosis or treatment. Naim notes that the most exciting tests are a couple of years away. Ian returns to Jörn's earlier point about the value of sequential testing vs an individual test. Louise suggests that device size will be pivotal for primary care.

00:35:30 - Impact of Resmetirom Price
Naim expresses concern over the $39-52K price he has heard for resmetirom. Roger states that price reflects size of target market. At that point, the discussion veers toward factors that drive drug prices higher.

00:40:22 - Impact of GLP-1s on treatment and resmetirom
Roger asks the group what the impact of consumer-driven GLP-1 use is likely to be on US prescribing of MASH drugs. Ian discusses use of GLP-1s in the UK and suggests that if the price for resmetirom is high enough, GLP-1s will receive significant use. Recent exciting results from BI and Akero suggest to Naim and others that the future for drugs is bright.

00:47:16 - Final question
This entails Roger summarizing what he has heard in the conversation and testing for confirmation or correction. It goes fast and covers significant ground.

00:53:26 - Question(s). of the Week
The question is what else will change, besides prescribing, once a drug is improved and what the industry can to do optimize change.

00:54:06 - Business