Multidisciplinary Care Model Improves Liver, Metabolic Outcomes in MASH

Jonathan Stine, MD, MSc

Credit: Penn State Health

New research is shedding light on the potential utility of a multidisciplinary care model for adults with metabolic dysfunction-associated steatohepatitis (MASH) and significant liver fibrosis, highlighting the benefits of a comprehensive care team approach.¹

The model involved a wide range of specialists and included a combination of individualized patient education, lifestyle intervention, and drug therapy approaches that led to significant improvements in both liver and metabolic health, effectively addressing the complexities unique to the clinical management of MASH.¹

“Given treating metabolic dysfunction in silos is ineffective, growing interest in multidisciplinary care models has emerged and leading hepatology societies endorse a multidisciplinary approach. Despite this guidance, multidisciplinary care is not widespread; only 30% of US academic medical centers offer this,” Jonathan Stine, MD, MSc, an associate professor of medicine and public health science at Penn State University, and colleagues wrote.¹ “Moreover, there is no agreed-upon care model that consistently improves outcomes, programs are rarely co-located in the same clinic, and important specialists are missing from most programs.”

In March 2024, the US Food and Drug Administration (FDA) granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra) for the treatment of noncirrhotic MASH with moderate to advanced fibrosis, making it the first and only FDA-approved pharmacologic treatment option for the progressive liver disease.² Although other agents are progressing through clinical development, including Novo Nordisk’s semaglutide and Akero Therapeutics’ efruxifermin, multidisciplinary care remains critical for improving outcomes.^3,4

To address the unmet clinical need for comprehensive, multidisciplinary MASH care, investigators designed and implemented a large program of 7 specialists colocated in the same clinical space to offer a single stop for patients. For inclusion in the study, patients could not have decompensated F4 and were required to have ≥ 1 of the following: FIB-4 ≥ 1.35; VCTE liver stiffness ≥ 8 kPa; MRE ≥ 2.55 kPa; ELF ≥ 7.7; or ≥ F2 on liver biopsy.¹

In total, 78 consecutive adults were enrolled in the multidisciplinary care model between October 2023 and August 2024. Investigators noted the cohort was mostly non-Hispanic White (85%) with F2/F3 (80%) disease and multiple metabolic comorbidities, including hypertension (67%), hyperlipidemia (50%), and diabetes (42%).¹

On the day of their clinic visit, the patient proceeded through sequential appointments colocated in the same clinic, during which time questionnaires, laboratories, and imaging tests were reviewed. Each patient received standardized lifestyle counseling about the following topics:

• Consuming a hypocaloric Mediterranean-informed diet with a goal of 10% weight loss
• Performing guideline-based physical activity
• Consuming three 8 oz cups of coffee per day and avoiding sugar-sweetened beverages
• Sleeping ≥7 hours per night
• Avoiding excessive alcohol
• Smoking cessation

Personalized meal plans and exercise prescriptions were provided where deemed appropriate, and patients were counseled on the benefits of drug therapy for MASH and/or metabolic comorbidities.¹

Investigators targeted systolic blood pressure (SBP) <130 mm Hg, LDL <100 mg/dL, and hemoglobin A1c <7%. Antiobesity medications and clinical trials were also offered to patients who met the established criteria, and referrals were made to bariatric surgeons, endobariatricians, sleep medicine experts, and a clinical psychologist.¹

Upon completion of the initial consultation, clinical data and individual provider recommendations were reviewed at a biweekly multidisciplinary MASLD board, and treatment plans were adjusted as appropriate and communicated to the patient.¹

Patients were contacted 6 months after their initial consultation to obtain an interim history, including assessment of changes in body weight, physical activity, medication compliance, and medication side effects. They then followed up in person 1-year post-consultation to complete the same procedures as their initial consultation.¹

Among the cohort, 26 patients had data available at 6 months. Investigators called attention to several improvements in liver health and metabolic health in these patients. Specifically, they noted 39% achieved a clinically meaningful reduction in ALT and 79% achieved A1c <7%.¹

Additionally, 72% of patients achieved LDL <100 mg/dL, including 69% of patients with diabetes. Results also showed 50% achieved SBP ≤130 mm Hg; 35% achieved guideline-based amounts of weekly physical activity; and 26% achieved body weight loss of ≥5%.¹

Investigators noted further studies are needed to validate these findings and to evaluate the cost-effectiveness of this multidisciplinary care model.¹

“This study provides novel evidence that a comprehensive, multidisciplinary care model involving a wide range of specialists can lead to significant improvement in liver and metabolic health through sustained lifestyle intervention in conjunction with targeted pharmacologic therapies,” investigators concluded.¹ “These findings suggest that expanding multidisciplinary care programs could greatly improve clinical outcomes for all patients with MASLD.”

References

1. Stine JG, Bradley D, McCall-Hosenfeld J, et al. Multidisciplinary clinic model enhances liver and metabolic health outcomes in adults with MASH. Hepatol Commun. doi:10.1097/HC9.0000000000000649

2. Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed February 19, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

3. Brooks A. ESSENCE: Semaglutide Improves Fibrosis, Resolves Steatohepatitis in MASH. HCPLive. November 1, 2024. Accessed February 19, 2025. https://www.hcplive.com/view/essence-semaglutide-improves-fibrosis-resolves-steatohepatitis-in-mash

4. Brooks A. Efruxifermin Reverses MASH Compensated Cirrhosis in Phase 2b SYMMETRY Study. HCPLive. January 27, 2025. Accessed February 19, 2025. https://www.hcplive.com/view/efruxifermin-reverses-mash-compensated-cirrhosis-phase-2b-symmetry-study