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This conversation is the third segment of SurfingMASH’s April discussion of drug development in memory of Stephen A. Harrison. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologists and key opinion leaders Sven Francque and Naim Alkhouri. 

Louise starts the discussion by asking when a patient is metabolically and hepatically healthy instead of merely driving weight loss. She notes that basing therapy entirely on weight loss goals will breed failure and frustration while failing to address the actual pivotal goal of metabolic health. Sven agrees and notes how important this point is. Roger suggests that the benefit of weight loss is likely to become limited over time, which is why there is such excitement about GLP-glucagon combination therapies. Again, Sven concurs, noting that such knowledge and increasing drug class diversity will allow researchers to look at true, basic differences between agents instead of "small numerical differences."

Jörn notes the importance of NITs in addressing these kinds of issues. Scanning is an effective method for measuring changes in liver fat; however, the academic community has developed surrogate NITs for specific physiological activities. As Sven notes, there is still a great deal of work to do here. That said, Jörn cites examples of large, NIT-based projects like the VCTE Study Group that have sufficient sample size to start building definitions around kilopascal levels. Louise shares her strong concern that many TE operators are not trained adequately to appreciate subtle clues that would tell an expert how an individual scan was providing misleading results. She notes that the increased demand for scanning, in this case TE, is going to drive a watering down of the qualifications and the skill of the user and the supervision level..." The discussion winds down with Sven agreeing with Louise and stating the need for sequential testing and Jörn citing EASL guidelines in stating that practices should provide and manage high-quality care to the best of their abilities.