S4-E40 - Review of Paris NASH 2023

Along with NASH-TAG, Paris NASH is one of two famously small, science-based and publicly available events every year for the liver community. Given the depth of topics and ideas explored in Paris, the event in its entirety would be nearly impossible to cover in a single conclusive episode. That said, the Surfers (Jörn Schattenberg, Louise Campbell and Roger Green) are joined by two presenting KOLs, Scott Friedman and Laurent Castera, for a neatly packaged conversation to capture some of the key dynamics of the meeting. Particularly, the group hone in on developments in the landscape around NITs.<br/><br/>This episode begins with Scott discussing the session he shared with Fabio Marra which investigates the link between fibrosis and regeneration. Scott points out that the liver's ability to regenerate is unique among organs and the question of how it does so is readdressed seemingly each passing decade without clear explanation. He goes on to note that injured livers are less likely to regenerate than healthy ones and that regenerative livers are less likely to scar. While we do not know which of these phenomena comes first, the answer is likely to have a broad range of implications not only for liver disease but also a range of other organs in addition. <br/><br/>Next, Laurent shares thoughts from his session with Mark Muthiah about the use and limitations of NITs. In a nutshell, Laurent explains why we need a range of tests to choose from depending on the question which we are looking for an answer. The reoccurring theme on the podcast around the importance of frontline education and training is addressed by Laurent here. Further, he underscores the value and simplicity behind FIB-4 as a simple frontline testing tool while also discussing its drawbacks. From here, Jörn and Louise ask relevant and interesting questions around what Laurent has discussed.<br/> <br/>Jörn moves on to discuss the question that goes once a drug is approved, which test will you use to determine whether a patient receives that therapy or not? Jörn promptly notes that he will use neither biopsy nor FIB-4 then comments that FAST was designed for this purpose, but doesn't rise to the level he would hope to find. Scott raises a parallel question that goes once you commit a patient to drug, how will it be determined that the patient is responding or not? The conversation continues to look into how to assess data at an individual level and learn more about how each patient variably responds to tests.<br/><br/>For a wrap up question, Roger asks for any other important or intriguing questions yet to be covered that arose in the meeting. Scott shares some interesting talks on genetics, while Laurent adds that he was struck powerfully by a talk on pediatric NASH. Jörn goes a different direction and discusses a statistical method for comparing disparate options known as DOOR, or desirability of outcome rankings, and its effect on how to compare drugs and different options in unique patient situations.<br/><br/>This conversation covers many more fascinating elements of another insightful Paris NASH meeting. Listen to the full episode and dive into this weekend's conversation to gain a richer understanding than can be described in this summary. If you have questions or comments around Paris NASH, NITs or any other themes addressed in this episode, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.<br/><br/>Stay Safe and Surf On!