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One serious challenge in the overall management of Fatty Liver disease involves creating cost-effective methods for "early" diagnosis. The term "early" is relative because, as Ian Rowe puts it, a "substantial proportion" of people admitted to hospital with various symptoms of decompensating cirrhosis or hepatic encephalopathy never received a diagnosis of advanced liver disease before they presented. Simply diagnosing these patients during advanced fibrosis (F2 or F3) can save lives, improve longevity and quality of life for these patients and save money for healthcare systems, all at the same time. 

Ian spends the first ten minutes of this episode describing a model he and Richard Parker developed to evaluate five diagnostic strategies:

• Targeted -- simple non-invasive liver screening 
• Targeted + risk stratification -- targeted assessment plus FIB-4 or VCTE (FibroScan) for patients believed to be at high risk
• iLFT -- automated assessment of abnormal LFTs analyzed with other systemic measures in a medical record system 
• "Comprehensive" -- a "kitchen sink" approach that runs iLFT analysis and conducts FIB-4 +/- VCTE on every patient
• "Fibrosis first" -- an approach that deploys viroserological and iron testing plus FIB-4 +/- VCTE for every patient 

"Fibrosis first" scored best in cost effectiveness (cost per correct diagnosis of treatable liver disease) and "decision curve analysis", which looks at true positive outcomes and false positive outcomes, correctly identifying 85% of treatable liver disease patients (vs. 90% for the comprehensive approach and less than 15% for the current targeted approach.)  Fibrosis first has the added benefit of not progressing treatment for people who may have steatosis without fibrosis. 

The rest of the conversation entails Ian, Louise Campbell and Roger Green sharing questions and observations. Highlights:

• Louise agrees that the current targeted pathway approaches do not work and  identifies lack of access to advanced testing in primary care as a central issue. She asks how many additional patients with Type 2 Diabetes, other metabolic diseases or CVD could be identified through this approach. Ian cannot answer because the question is outside the scope of the research. He points out that to assess different approaches accurately, researchers and policymakers need to settle on whether the goal is to identify steatohepatitis or something broader. 
• Louise asks about the frequency and nature of referrals. Ian notes that one issue with iLFT is a high level of referrals for conditions that might not require treatment, the most common of which is "abnormal LFT without fibrosis."
• Roger notes that iLFT might help patients who complain they never heard about their NASH earlier. He also recalls Quentin Anstee and Stephen Harrison discussing recently that FIB-4 can serve as a prognostic measure not only for liver-related deaths, but also CV deaths and all-cause mortality. 
• Louise suggests that patients will do better if they adopt a  behavior belief model instead of a sick patient approach and that the earlier in disease we intervene, the more success we will have. Roger and Ian note that Louise’s focus is broader in scope than his model. Ian further notes that we do not know when non-fibrotic patients should be tested again, although he has some thoughts about this. 
• Louise notes that one element that might make iLFT costly is that only 45% of patients picked up on iLFT are referred into the model. Ian notes that this insight might require changes in the model.

As the conversation winds down, it shifts toward policy issues: should we focus testing on the workforce (Louise) and it the best point of intervention to limit advertising of unhealthy foods (Ian).

S3-E39 - Reviewing a Decision Model for Early NASH Diagnosis

Navigating NAFLD/NASH clinical trials through the pandemic

Dr. Stephen Harrison discusses several ways the pandemic is affecting the planning and execution of clinical trials and our panelists discuss implications for investors, C-suite executives, and forecasters in our first episode, COVID CHAOS: Navigating NAFLD/NASH clinical trials through the pandemic. 

(FULL TRANSCRIPT: https://bit.ly/COVID-Chaos)

Drug developers, investors, researchers, and corporate executives, wrestle weekly to understand what is happening in commercial development of NASH medications. Join hepatology researcher and key opinion leader, Stephen Harrison, star equity analyst, Yasmeen Rahimi, C-suite veteran, Peter Traber, and forecasting and pricing guru, Roger Green, as they discuss the issues affecting the evolving NASH market from their own unique perspectives on this week’s edition of Surfing the NASH Tsunami.

Roger Green (00:31): Hi. This is Roger Green, and welcome to the initial podcast of Surfing the NASH Tsunami, a podcast for people who are involved with drug development and commercialization in the liver disease space. We’ve developed this podcast because over the last month we’ve heard tons of questions from virtually everybody involved in this community about the impact of COVID, first, and then how that’s going to affect the entire domino chain of upcoming market events, product readouts, clinical trials, launches, all that going forward.

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

COVID CHAOS - Ep 1

What investors want to know about NASH development during the pandemic.

Yasmeen Rahimi poses five questions NASH investors ask her about the impact of COVID-19 on NASH clinical and commercial development and our panelists provide answers in our second episode, FIVE $IMPLE PIECES: What investors want to know about NASH development during the pandemic.
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Epsiode Transcription: https://bit.ly/WhatInvestorsWantToKnow

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

Five $imple Pieces - Ep 2

Critical considerations for companies developing NASH drugs

Peter Traber focuses on ways COVID-19 can affect drug development and broader corporate strategies while our panelists weigh in on implications for clinical researchers, investors and forecasters in our third episode: C-SUITE COVID-19 CHALLENGES.

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Full Transcription: https://bit.ly/CSuiteCOVID19Challenges

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

C-Suite COVID-19 Challenges - Ep 3

Three possible scenarios for development of the NASH market.

Roger Green presents three possible directions for the NASH market over the next 5-10 years and asks our panelists, including our guest, renowned nurse and patient advocate Louise Campbell, to suggest critical market-driving factors.

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Full Transcription: https://bit.ly/Ep4-Surfing-NASH

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

When You Get To A Fork In The Road - Ep 4

Clinical trial results that are changing how we look at NASH

Stephen Harrison leads a review of two recent Phase 3 data statements: the outcome of GenFit’s RESOLVE-IT trial and Madrigal Pharmaceuticals’ recent press release on the extension of its MAESTRO Phase 3 NASH trial. Listen to a thoughtful, far-reaching sometimes funny conversation as the group explores WILD TIMES IN NASH-VILLE – PART I.

Full Transcript: https://bit.ly/Ep5-NASH-VILLE-Pt1

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

Wild Times In NASH-Ville – Part I - Ep 5

Exploring the controversy over the name(s) to use when describing Fatty Liver disease(s)

Professor Quentin Anstee joins the Surfers for thoughtful consideration of the factors that should drive the decision on what name(s) to use for different Fatty Liver diseases. The group considers a range of issues from our level of scientific knowledge to the semiotics of naming to how patients react to certain disease descriptions, all in a stimulating, freewheeling discussion.

Full Episode Transcripts: https://bit.ly/Ep6-WhatsInAName

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

What’s in a Name: NAFLD or MAFLD? - Ep 6

Reviewing press releases reporting preliminary findings from six recently announced Phase 2 trials

Stephen Harrison leads the Surfers, with guest Louise Campbell, through an examination of six Phase 2 clinical trials that put forth press releases during the last three months. In all, the discussion created an air of optimism based on better clinical outcomes than we have seen with earlier NASH drugs, all from medicines with distinct but potentially complementary modes of action.

Full Episode Transcripts: https://bit.ly/Ep7-NASH-VILLE-Pt2

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

NASH-Ville - Part 2: Better Days Ahead? - Ep 7

Room for improvement

GenFit Head of Global Diagnostics Suneil Hosmane joins the Surfers in exploring the current strengths and drawbacks of Fatty Liver diagnostics. The conversation considers the needs of drug developers, clinicians and patients, and highlights opportunities for improving diagnostic options.

Full Episode Transcripts: https://bit.ly/Ep8-Diagnostics-Pt1

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

Diagnosing Diagnostics – Part I - Ep 8

Surfing the NASH Tsunami celebrates a growing and increasingly important global event for the Fatty Liver community.

Global Liver Institute President & CEO Donna Cryer joins the Surfers to discuss the focus, passion, and advocacy that have shaped and grown International NASH Day. Learn how IND started and what it represents today. As you listen, envision the role you can play in the future of Fatty Liver advocacy and education.

Full Episode Transcript: https://bit.ly/Ep9-International-NASHDay

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

International NASH Day is Here! - Ep 9

What would create greater value for patients and providers?

Professor Mary Rinella of Northwestern University and Suneil Hosmane of GenFit join Stephen, Louise, and Roger to explore which of these strategies can do the most to improve patient diagnosis and management. The answer might surprise you.

Full Episode Transcripts: https://bit.ly/Ep10-Diagnosing-Diagnostics-Pt2

Apple Podcasts: https://bit.ly/NASH-Podcast-Apple
Spotify: https://bit.ly/NASH-Podcast-Spotify
Stitcher: https://bit.ly/NASH-Podcast-Stitcher
Buzzsprout: https://bit.ly/NASH-Podcast-Buzzsprout
YouTube: https://bit.ly/NASH-Podcast-YT

Diagnosing Diagnostics II: Tools vs. Teaching - Ep 10

Drug developers, investors, researchers, and corporate executives wrestle weekly to understand what is happening in commercial development of NASH medications. Hepatology researcher and Key Opinion Leader Stephen Harrison, M.D., C-suite veteran Peter Traber, M.D., and Forecasting and pricing guru Roger Green, M.B.A. discuss the issues affecting the evolving NASH market from their own unique perspectives on the Surfing the NASH Tsunami podcast.

S3-E39 - Reviewing a Decision Model for Early NASH Diagnosis

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