Ask the author session with Prof. Caussy

For specialists working in diabetology and related fields, identifying patients with metabolic dysfunction-associated steatotic liver disease (MASLD)-related advanced fibrosis (AF) is a significant challenge. Effective screening and management strategies are crucial.

A recent publication in Diabetes Care, titled “Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease-Related Advanced Fibrosis in Diabetology: A Prospective Multicenter Study,” tackles this challenge head-on. The study, co-authored by Professor Cyrielle Caussy, an expert in diabetology and fatty liver disease, aimed to compare the performance of noninvasive tests (NITs) and two-step algorithms for detecting patients at high risk of AF who require referral to hepatologists.

Professor Caussy was recently featured in an “Ask the Author” session to discuss this important work. During the session, she described the study’s design, highlighting its novelty as one of the first screening strategies specifically performed in a diabetology setting. Previous data on NIT accuracy often came from patients recruited in hepatology with biopsy-proven MASLD.

The study included participants with type 2 diabetes and/or obesity and MASLD. A comprehensive liver assessment was performed, including various blood-based NITs like FIB-4, FibroMeter, Fibrotest, and the Enhanced Liver Fibrosis (ELF) test, as well as liver elastography using vibration-controlled transient elastography (VCTE) and two-dimensional shear-wave elastography (2D-SWE). AF risk stratification used a hierarchical composite criterion based on liver biopsy, magnetic resonance elastography (MRE), or VCTE ≥12 kPa if biopsy or MRE were unavailable. Patients with high BMI (>40 kg/m2) or other causes of liver disease were excluded to ensure accuracy.

Key findings from the study and discussion:

• Among the 654 patients included, 17.6% had an intermediate/high risk of AF, and 9.3% had a high risk of AF. This indicates a substantial proportion of patients in this population require further assessment and potential referral.
• Various NITs showed good diagnostic performance for detecting high risk of AF, with area under the curves (AUCs) ranging from 0.74 for FibroMeter to 0.84 for SWE and 0.82 for the ELF test.
• Two-step algorithms demonstrated excellent diagnostic performance for referral of patients at intermediate/high risk. The FIB-4 score/VCTE algorithm was highlighted as showing excellent diagnostic performance and applicability for routine screening in diabetology.
• An alternative FIB-4 score/ELF test strategy, using an adapted low threshold of 9.8, also showed a high negative predictive value (NPV) of 88-89%. The FIB-4 score/2D-SWE strategy had an NPV of 91%.
• Using an age-adapted FIB-4 score threshold resulted in lower NPVs and positive predictive values (PPVs) in all algorithms.
• These strategies are applicable and efficient for risk-stratifying patients in diabetology clinics.
• Implementing such a screening pathway can help identify patients who need to be referred to hepatology. Critically, the study found patients with previously undiagnosed compensated cirrhosis.

Professor Caussy’s advice to colleagues considering implementing such a pathway is clear: “just do it”. She emphasizes that using simple tools, starting with FIB-4, works well. The majority of patients will be classified at low risk, requiring only reassurance, while those with elevated FIB-4 can proceed to a second-line test available in their setting to identify those needing referral. Using the recommended tools works and helps find patients who need intervention, including those with unknown cirrhosis.

For diabetologists, endocrinologists, and other specialists managing patients at risk for MASLD-related advanced fibrosis, understanding how to effectively implement screening in clinical practice is vital. This study provides a strong evidence base for using two-step noninvasive strategies.

We invite you to watch the full “Ask the Author” session with Professor Cyrielle Caussy to gain deeper insights into the study methodology, results, and practical advice for putting this clinical pathway into place.

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Ask the author session with Prof. Castera

Are you a healthcare professional specializing in hepatology or related fields? Do you grapple with the increasing prevalence and complex management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and its more severe form, Metabolic Dysfunction-Associated Steatohepatitis (MASH)? If so, we invite you to delve into a crucial discussion featuring Professor Laurent Castera, a renowned investigator in hepatology, particularly in the field of steatohepatitis.

Professor Castera, working at Hospital Beaujon in Paris, recently published a significant paper in “Liver International” titled “A European Survey to Identify Challenges in the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease“. This study, conducted in 2023 across five European countries (France, Germany, Italy, Spain, and the UK), aimed to pinpoint the difficulties in diagnosing, treating, and managing individuals with MASLD and MASH, as well as to understand the obstacles hindering the adoption of relevant clinical guidelines.

In a recent “Ask the Author” session hosted by Professor Jean-François Dufour, Professor Castera presented the key findings of this important work. This engaging video provides valuable insights into the current landscape of MASLD and MASH management from the perspective of a diverse group of physicians.

Key Highlights from the Study and Discussion:

• The study employed a real-world, cross-sectional design, incorporating both quantitative surveys and qualitative interviews with physicians.
• A significant number of physicians acknowledged the high impact of MASLD or MASH on the management of patients with obesity and type 2 diabetes, with 66 to 69% of respondents indicating this. This underscores the strong association between these conditions.
• However, a notable challenge identified was the lack of awareness regarding MASH-specific clinical guidelines issued by international societies, with over one-third (35%) of respondents unable to recall any such guidelines. Awareness was better for national guidelines.
• To enhance the adoption of guidelines, physicians expressed a need for evidence of success (48%) and clinical guidelines addressing common MASLD comorbidities (38%).
• The discussion highlighted the particular challenge of reaching and educating first-line physicians, such as GPs, who may not prioritize liver health in patients with known risk factors like obesity and type 2 diabetes. Their awareness of non-invasive diagnostic tools like FIB-4 and FibroScan, as well as clinical pathways, was also reported to be low.
• Professor Castera emphasized that education, increased awareness, and the dissemination of pathways and guidelines are crucial for improving management.
• The upcoming availability of treatments for MASLD/MASH is anticipated to be a significant catalyst for increased awareness and screening efforts.

This video offers a concise yet comprehensive overview of the challenges faced by physicians in managing MASLD and MASH across Europe. It provides crucial context for the evolving landscape of this prevalent liver disease, especially with the imminent arrival of new therapeutic options.

We strongly encourage specialists in hepatology, gastroenterology, endocrinology, and general practice to watch this insightful discussion. Understanding the perspectives and challenges faced by colleagues across Europe is vital for improving patient care and ensuring the effective implementation of future treatments and guidelines.

Click here to watch the video and gain valuable insights from Professor Castera’s expert analysis.

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