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New Drugs Show Promise for Reversing Liver Disease

June 8, 2020


Underscore Need for Early Detection

Many of us are familiar with liver disease caused by excessive alcohol intake, but with the increasing rates of Type 2 diabetes and obesity, non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of end stage liver disease and liver cancer. Weight loss can improve liver conditions of people who have obesity or are overweight, whether through lifestyle changes or weight-loss surgery. In one study, researchers found that individuals who achieved a weight loss of 10% or more after one year of lifestyle changes involving a low-calorie diet and exercise experienced reductions in NAFLD, a condition in which fat builds up in the liver in people who drink little or no alcohol.  In addition, 90% of people with a >10% weight loss experienced resolution of nonalcoholic steatohepatitis (NASH), the more severe form of NAFLD, and 45% showed regression of fibrosis, the formation of fibrous scar tissue. Weight loss of 7-10% also reduced disease severity in some patients, including men and those without diabetes.

Novo Nordisk’s popular GLP-1 diabetes drug semaglutide—a weight loss drug—has also generated encouraging clinical results. Further studies are needed to see if semaglutide can reverse fibrotic-NASH. Novo states that its clinical results represent “the largest NASH resolution improvement so far,” confirming that the drug could be a potent anti-NASH agent.

Promising Drugs on the Horizon

In the phase 2 trial for semaglutide, a significantly higher percentage of patients on daily injections saw resolution of the effects of NASH — liver inflammation improved and liver cell ballooning eased—with no worsening in liver fibrosis than placebo patients experienced.

Another drug in the pipeline, obeticholic acid (OCA), has shown it can improve liver fibrosis in 23.1% of patients, almost double the 11.9% rate investigators observed with placebo. OCA could be the first drug approved to treat fibrotic-NASH.

With the introduction of new treatment options, a targeted chronic care disease management (CCDM) program can help cost-effectively assess and manage the risk factors for NAFLD.  Consistent scoring of liver stiffness and fat with FibroScan®, a non-invasive point of care examination supports the launch of these drugs in a way that improves outcomes and lowers costs for employers and payers.

CCDM Program Can Leverage NASH Drugs

Because liver disease is asymptomatic, it has become critically important to routinely monitor of both liver fat and fibrosis in people at higher risk. Ongoing point of care monitoring of NAFLD is particularly important for people who have obesity and Type 2 diabetes because these patients may be at increased risk of cirrhosis and liver cancer.
MetaPhy Health, providers of chronic care management services for gastroenterology practices, has developed CCDM programs that leverage Echosens’ FibroScan®, a non-invasive technology that quickly provides a quantitative assessment of liver stiffness and liver fat at the point of care, to make the detection of liver disease and long-term care for individuals with NAFLD and NASH more effective.

Implementing a CCDM program that targets liver health can address the broader needs of patients/members and prevents them from developing NASH. In fact, this is a critical imperative given the costs and complications associated with NASH–a challenging, high-volume and chronic condition that lacks a standardized care delivery model.