Fatty Liver Disease in the Spotlight at The Liver Meeting

Laird Harrison

November 02, 2018

SAN FRANCISCO — Research on treatments for patients with fatty liver disease and nonalcoholic steatohepatitis, in particular, will be highlighted at The Liver Meeting 2018: American Association for the Study of Liver Diseases (AASLD).

"Because NASH is by far the most prevalent liver disease in the United States, most of the drug development has centered on that," said Nancy Reau, MD, from Rush University Medical Center in Chicago.

Multiple drugs for the disease are making their way through the pipeline, she told Medscape Medical News. "We really do expect therapy for this. Will it be good therapy? Will we want to use it? That's different. But we will get drugs."

Results from phase 2 studies of drugs for nonalcoholic steatohepatitis — Mgl-3196 (Madrigal Pharmaceuticals), obeticholic acid (Ocaliva/Intercept Pharmaceuticals), GS-9674 (Gilead Sciences), NGM282 (NGM Bio), arachidyl amido cholanoic acid (Aramchol, Galmed Pharmaceuticals), and tropifexor (Novartis) — will be presented.

Also presented will be phase 2 results for VK2809 (Viking Therapeutics), a treatment for nonalcoholic steatohepatitis and other nonalcoholic fatty liver diseases, and results for myrcludex B (MYR Pharma), a treatment for hepatitis B and D.

But no less important than the development of new drugs is precision in the use of existing therapies.

Researchers are figuring out how to make better use of the treatments they have on hand, particularly for hepatitis C and hepatocellular carcinoma, said Kimberly Brown, MD, from the Henry Ford Health System in Detroit, who is cochair of the scientific programming committee for the meeting.

A study from Cleveland Clinic researchers examines what happens when solid organs from donors infected with hepatitis C are transplanted into patients without the virus. Results could determine whether such donations are safe and expand the pool of organs available for transplant.

"This is a very big deal," Brown told Medscape Medical News.

Another issue of concern in the transplant community is the obesity of donors and recipients. A study of fatty liver and normal liver transplantations into obese and normal-weight recipients will be presented by a group from the University of Virginia.

Hepatocellular Carcinoma

Hepatocellular carcinoma is "one of the only cancers where mortality continues to increase," said Reau. But researchers are working toward solutions.

The combination of entecavir plus tenofovir has helped reduce the incidence of this cancer in patients with chronic hepatitis B, but it has not been eliminated.

An international team of researchers will present findings on the surveillance needed in these patients. "It would be great if we could figure out a group of patients that we didn't have to screen for cancer," Brown said.

The question of whether the PD-1 inhibitor nivolumab is as safe and effective for patients with a class B Child-Pugh score as it is for patients with a class A score will also be addressed. This is of particular interest because most patients with advanced hepatocellular carcinoma have a class B Child-Pugh score.

Drugs for hepatitis C are now saving lives that would have been lost only a decade ago. But not everyone with this virus has access to these powerful treatments.

Researchers from the National Institutes of Health and the University of Maryland will discuss the effectiveness of therapy for hepatitis C in people who inject drugs and policies for treatment.

"This is important to us because the majority of patients who have new hepatitis C are using intravenous drugs," said Brown. "There has been a long-standing opposition on the part of insurers to treat this population of patients. Things that are cited are the risk of nonadherence and ongoing drug use."

Adherence in this population and the benefits of the combination of sofosbuvir and velpatasvir will be explored.

In a related project, findings from a study of glecaprevir and pibrentasvir in treatment-naïve patients with hepatitis C and compensated cirrhosis will reveal whether the standard 12-week regimen can be shortened to 8 weeks.

Reau reports financial relationships with AbbVie, Abbott Laboratories, GENFIT, Gilead Sciences, Merck, Bristol-Myers Squibb, and Shire. Brown reports financial relationships with Gilead, Merck, and Pfizer.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Laird Harrison @LairdH

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