Naim Alkhouri, MD: Using AGILE Scoring to Estimate MASLD Fibrosis, Cirrhosis

Although several noninvasive tests have emerged as potential alternatives to liver biopsy for determining the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD)-related fibrosis and cirrhosis, their overall accuracy and positive predictive value lead to potentially inaccurate estimations.¹

AGILE 3 + and AGILE 4 may offer viable alternatives for assessing fibrosis and cirrhosis, respectively. The non-proprietary tests were developed in order to optimize the positive predictive value of noninvasive testing and seek to provide fewer indeterminate results without the need for liver biopsy, as they can be calculated using routinely collected clinical, elastography, and laboratory parameters.¹

Leveraging National Health and Nutrition Examination Survey (NHANES) 2017-2018 transient elastography data, Naim Alkhouri, MD, chief medical officer, chief of transplant hepatology, and director of the Fatty Liver Program at Arizona Liver Health, and colleagues calculated AGILE 3 + and AGILE 4 scores to estimate the prevalence of MASLD-related advanced fibrosis and cirrhosis, seeking to address limitations of and shortcomings to other noninvasive tests that may provide inaccurate estimates.¹

“We estimated that probably 8.1% of the population is at risk for advanced fibrosis, and we estimated that maybe 1.1% of the population is at risk of having MASH cirrhosis. These numbers translate into about 4.5 million American adults at risk for advanced fibrosis, and about 600,000 Americans at risk for cirrhosis,” Alkhouri explained to HCPLive, noting the research was conservative with the cut points they used for maximizing positive predictive value. “The message for me is that even by using a conservative approach, a large percentage of the American adult population may have advanced fibrosis related to MASLD and MASH.”

Emphasizing the availability of effective treatment approaches, Alkhouri stressed the importance of identifying patients before they progress to cirrhosis, at which point they become much more difficult to treat. In addition to weight loss, a US Food and Drug Administration-approved liver-directed therapeutic is available for patients with moderate to advanced fibrosis, and others are progressing through the hepatic pipeline and are expected to be available in the future.²

“I think it is very important that we actually utilize these scores and utilize them properly. We don't want to overdiagnose people with advanced disease and put them unnecessarily on medications, but we also don't want to continue with this sense that there's nothing you can do about it, because there's a lot that you can do about it,” Alkhouri concluded.

References

1. ^{Brooks, A. Study Estimates MASLD-Related Fibrosis, Cirrhosis Prevalence Using AGILE Scoring. HCPLive. July 26, 2024. Accessed August 9, 2024. https://www.hcplive.com/view/study-estimates-masld-fibrosis-cirrhosis-prevalence-agile-scoring}
2. ^{Brooks, A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed August 9, 2024. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash}