Rohit Loomba, MD, MHSc: Future Treatments and Strategies in MASH

With the adoption of new nomenclature regarding metabolic-associated steatohepatitis (MASH) over the previously known non-alcoholic steatohepatitis (NASH) comes opportunity to consider refined means of adequately screening, monitoring and treating the liver disease in suspected patients. Some practices have already applied more nuanced tools to reflect the evolving definition of MASH and metabolic-associated liver diseases—tools that which may also help distinguish the first viable treatment options for such patients.

In the second segment of an interview with HCPLive during The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this weekend, Rohit Loomba, MD, MHSc, chief of the USCD Health division of gastroenterology and hepatology and director of the UCSD NAFLD Research Center, discussed his team’s strategy for diagnosing and monitoring MASH and MASLD disease status.

“I think when we have patients with MASLD coming in, we're using additional liver testing, such as FibroScan, MR elastography, looking at liver stiffness and fibrosis non-invasively. We routinely do that in our clinical practice here,” Loomba said. “We also use other fibrosis tests that are based on blood-based biomarkers such as enhanced liver fibrosis panel FIBROSpect II, and in some cases, PRO-C3, those could be utilized as well.”

In order to better differentiate between metabolic dysfunction-borne fatty liver versus alcohol-associated fatty liver, Roomba and colleagues remain dependent on patient history—gauging how much they drink and their responses to standardized questionnaires. But it may not be enough to adequately ascertain their condition.

“So we are now backing that up with additional tests,” Loomba said. “And those data as to what cut points will or won't be utilized, will be coming out in future. But I am routinely using PEth testing, which is phosphatidylethanol. That gives you an idea of alcohol use in the last 2-3 weeks.”

PEth testing may also provide clinicians a clearer differentiation between patients who are drinking excessively and those who may actually have MASLD, Loomba said—a standardization in the test that he believes will become available within 1 – 2 years.

As clinical agents under investigation by Loomba and colleagues such as pegozafermin progress toward late-stage assessments, hepatologists are considering more markers of MASH / MASLD treatment response. Loomba discussed his team’s MASH Resolution Index, which takes into account fat fractions, blood tests, serum LT and ALTs to predict the likelihood of curing the liver disease on a biopsy.

“I think those types of panels and tests that combine imaging with blood test would be utilized more and more,” Loomba said. “And this can give you a pretty decent idea whether this patient is improving their MASH or not.”