Listen Now

Guest Ian Rowe and Dr. Kris Kowdley join the Surfers to discuss how the 2nd COVID wave and arrival of the vaccine are likely to affect patient treatment and clinical development.In Episode 39, hepatologists Ian Rowe and Kris Kowdley, who divide their time more or less evenly between patient clinics and clinical trials, join the Surfers to discuss how the Second Wave of COVID-19 will affect patient treatment and clinical trials. This conversation turns conventional wisdom on its ear. The Surfers focused less on individuals' behavior and more on supply chain disruptions, growing shortfalls in the number of available healthcare workers and large-scale dislocations that will occur after the vaccine is in place. This episode challenges underlying assumptions about how the next few years might evolve and what will matter most.

Prof.  Vlad Ratziu, MD, and Prof. Dr. Jörn M. Schattenberg join the Surfers to wrap up our conversation about this year's AASLD meeting.Prof. Dr. Jörn M. Schattenberg erg and Prof.  Vlad Ratziu, MD join the Surfers for our wrap-up episode for TLMdX 2020. Joern focuses on a diabetes poster demonstrating the path of drug efficacy over a three-year period, while Vlad focuses on the successful Phase 2 trial of the pan-PPAR lanifibranor. The group also asks why placebo response varies so much between studies and whether the ratio of F2:F3 patients may be a factor. Finally, the Surfers focuses on what they consider the biggest lessons emerging from the meeting.

The Surfers spend the final day of AASLD 2020 looking at two very different sets of issues. Issue 1: challenges proving efficacy in F2 populations, particularly in terms of fibrosis. Issue 2: social burdens of poor dietary choices around the world, particularly given how developing PNAFLD (pediatric non-alcoholic fatty liver disease) can create a metabolic burden that can last a lifetime. In the end, the group remained optimistic about the explosion of knowledge around drugs and diagnostics for NASH and NAFLD but troubled by the lack of social policy, awareness or education around these issues.

Reviews of Phase 2 drug trials and diagnostic strategies reveal that NASH is close to multiple breakthroughs.Naim Alkhouri and Mazen Noureddin join Louise and Roger to review highlights from Sunday at The Digital Liver Meeting. Naim, Mazen and Roger review results from drug trials that reveal that multiple drugs (monotherapies and combinations) with potent effects on liver fat reduction and fibrosis are moving through the pipeline. Louise discusses a trial that relies on non-invasive techniques to assess histologic improvement and fibrosis regression in cirrhotic patients, signaling one more way that non-invasive techniques might replace biopsy. Finally, Louise and Roger team up to discuss a US-based 20-year study showing us the many ways that lean NASH prognosis and co-morbidities differ from overweight or obese NASH. A session filled with information, theorizing and high spirits!

Manal Abdelmalek joins the Surfers to review some of Saturday's most exciting presentations and posters from AASLD 2020, followed by a discussion of an exciting new hand-held diagnostic.Manal Abdelmalek joins the Surfers in a free-flowing discussion of Saturday's key papers and posters. Much of the talk focused on Lean NASH -- what it is some of the new diagnostic analyses and algorithms used to identify patients with or at risk of the disease. Stephen talked about the extraordinary path that seladelpar took through its Phase 2 NASH trial and Roger revisited an old podcast question: can Patient-Reported Outcomes be part of clinical development planning and, if so, for what kinds of drugs. Finally, the Surfers welcomed Dr. Nezam Afdhal of Harvard and George Aliphteras of Sonic Incytes in a sponsored extra-sode that is part of the rollout of Velacur, their handheld liver health assessment device. The discussion moved quickly and at the end, all the Surfers were struck powerfully by how dynamically we are learning about this disease.

Prof. Dr. Jörn M. Schattenberg joins the Surfers to discuss his recent article in Expert Opinion on Investigational Drugs dissecting recent drug trial failures.Prof. Dr. Jörn M. Schattenberg joins Stephen, Donna, Louise and Roger to discuss his recent article "The Nonalcoholic Steatohepatitis (NASH) drug development graveyard: established hurdles and planning for future successes." The discussion started with lessons from failed trials, focusing on the importance of utilizing Phase 2 trials to test hypotheses and establish appropriate targets. From there, Surfers went on to discuss commercial and patient-focused definitions of what makes a clinical trial successful.

Stephen Harrison, Roger Green and our guest Surfer, Dr. Manal Abdelmalek, identify pivotally important presentations and posters from The Digital Liver Meeting 2020SurfingNASH continues our AASLD coverage by asking Stephen Harrison, Roger Green, and guest Surfer Dr. Manal Abdelmalek to identify and review abstracts they consider important or uniquely interesting. The abstracts they chose focus on exciting new agents, the emerging role of #artificialintelligence (AI) and machine learning inpatient diagnostics, and several issues surrounding lean NASH. AI-guided patient-level diagnostics? The story that emerges: a world where patients are diagnosed earlier and treated with agents that drive rapid response. Better liver health, better treatment of the entire range of metabolic non-communicable diseases...very intriguing!

Louise Campbell, Donna Cryer, and Naim Alkhouri identify pivotally important presentations and posters from The Digital Liver Meeting 2020.SurfingNASH kicks off its AASLD coverage by announcing four of our seven KOL guest Surfers. One of them, Dr. Naim Alkhouri, participates via interview. Naim, Louise Campbell, and Donna Cryer identify abstracts they consider important or uniquely interesting. The abstracts they chose focus on population health (particularly juvenile and pediatric NASH) and the link between NASH, obesity, metabolic factors, and death due to cancer. The issue of treating pediatric and adolescent NASH is tremendously challenging with issues involving diagnosis (are biopsies in children a good idea?), new agent testing (is the benefit ration for clinical trials in adolescents and pediatrics worth the risk?), and social education (how and what do we teach families)? An important and thoughtful episode for healthcare providers as well as anyone interested in public health or forecasting future use of medications and diagnostics.

Guest Surfer and regular listener Dr. Ian Rowe joins the Surfers to discuss how everyday patient treatment in the clinic once was and how COVID-19 and the news we discuss weekly on SurfingNASH have changed practice.This week's Guest Surfer, Dr. Ian Rowe, devotes roughly half his time to treating patients in his Hepatology practice in Leeds, UK, and the other half on research and teaching issues. He joined the Surfers to discuss how patients were referred to his clinic and how he treated them before COVID-19, and how the demands of the pandemic have changed practices in the clinic. Not surprisingly, the conversation turned to the best way to use the diagnostics we have and how events of the past year have increased the productive focus on using better diagnostics while simultaneously using diagnostics better. Along the way, learn about a significant research effort (350,000 patient records!) Dr. Rowe and his colleague, Dr. Richard Parker have undertaken and why sequential use of multiple non-invasive tests may offer the winning strategy for improving patient treatment.

On the six-month anniversary of SurfingNASH's first episode, the Surfers stop to consider how much has changed for NASH stakeholders since AprilThursday marks the six-month anniversary of SurfingNASH's first episode. The last six months have seen both setbacks and large steps forward in drug development, major advances in disease knowledge and increased breadth and depth of patient advocacy. The Surfers reflect on all these changes while remembering key steps in the podcast's evolution. Past guest Surfers Tony Villiotti of NASH kNOWledge and Suneil Hosmane of GenFit add their own reflections about what has changed.

Matt Kelly, Chief Innovation Officer at Perspectum, Ltd., joins the Surfers to discuss early findings from the COVERSCAN study which looks at the relationship between COVID-19 infection and major end-organ systems.Matt Kelly, Chief Innovation Officer at Perspectum, Ltd. joins the Surfers to discuss two studies that look at the relationship between COVID-19 and the liver. In the COVERSCAN study, Perspectum plans to conduct multi-organ scans of 500 patients who have recovered from a COVID-19 infection at two-time points: post-infection and six months later. The goal was to establish the impact of the COVID-19 infection on all the body's major organ systems. During this podcast, Matt discusses the results of the first round of scans on the first 200 patients. In the current UK BioBank analysis, UK BioBank culled through its database of 500,000 patients aged 40-75 to find 1,000 who had prior COVID-19 tests and imaging and compared the 10% of these patients who tested positive to the rest of the cohort. Both sets of results suggest a complicated relationship between fatty liver and severity of COVID-19 infection. This new research is producing eye-opening results that challenge conventional thinking. Perhaps our most important episode to date...Browse Our NASH and COVID-19 Coverage https://surfingnash.com/covid-19/

Stephen Harrison leads the Surfers through a review of FGF-21s and other exciting drug development news.Stephen Harrison starts this week's discussion reviewing the recent announcement of a promising Phase 1b/2a study for 89bio-100 (link to slide deck below), an FGF-21 agent that demonstrated significant reductions on liver fat and had positive effects on other metabolic measures. The discussion broadened to address an array of issues: other agents in development; changing (higher) expectations for how these agents will affect PDFF and possibly fibrosis; possible directions for combination therapy; and the five clinical values that collectively tell us the impact new medications can have on overall liver and metabolic health. One Surfer described this as a "brilliant 20-minute review." 89bio-slide deck: http://bit.ly/89bio-report

The Surfers discuss four issues that are likely to affect how our thinking about NASH diagnosis, education, and treatment might evolve over the next three months.Naim Alkhouri joins the Surfers to discuss some key NASH-related questions. The four key sections address upcoming clinical trials, steps forward in patient advocacy, the UK NCD report and need for patient education, and the pervasive impact of COVID-19 on how we think and talk about liver disease. Always lively, always provocative, and occasionally humorous, this episode is worth a long listen.Browse Our NASH and COVID-19 Coverage https://surfingnash.com/covid-19/

The Surfers discuss the Global Liver Institute's campaign to educate and motivate key stakeholder groups on the value of non-invasive liver testing. Donna Cryer, President and CEO of the Global Liver Institute, discusses GLI's "Beyond the Biopsy" campaign while Stephen Harrison, Louise Campbell, and Roger Green join in with education, messages, and ideas. The "Beyond the Biopsy" campaign focuses on the importance of gaining acceptance for non-invasive liver testing. Stephen discusses why validation matters and why "H" is a magic letter. Roger discusses the history of statins and the importance of what appears on blood testing results. Louise discusses simple things that healthcare can do to diagnose and treat liver disease before it becomes deadly. An eye-opening episode!

Professors Joern Shcattenberg and Vlad Ratziu join the Surfers to discuss the lessons and findings we can take away from Digital ILC 2020.What happens when seven people with diverse and divergent perspectives consider the implications of last week's Digital ILC meeting? Professors Vlad Ratziu and Joern Schattenberg join the Surfers to reflect on many insights, some leading to clashing outlooks. From Peter Traber's opening comments about the increasing convergence and energy around NASH to a closing discussion on how a finding on that liver disease is, in fact, the leading cause of mortality in NAFLD patients (a finding that, in the words of one Surfer, "stood things on their head," ) this was a rollicking, passionate conversation with equal parts agreement, challenge, mutual respect and, of course, humor. Listen twice to get all the small points!

SurfingNASH's Digital ILC coverage ends with three late-breaking drug presentations, a discussion of EASL's COVID efforts, and insights on patient management.Professor Joern Schattenberg joins the Surfers to discuss the last day of Digital ILC. Donna Cryer and Roger Green praise the work EASL has done pulling together data and analysis on how #liverdisease affects #COVID19 treatment decisions and outcomes, while Louise Campbell discusses research-in-process and Stephen, Peter Traber and Prof. Dr. Jörn M. Schattenberg discuss two exciting drugs in development and combination therapy that teaches us lessons about underlying liver dysfunction. In the end, Donna discusses GLI's "Beyond the Biopsy" initiative. This episode is knowledge-dense but entertaining... and totally a "can't miss" episode!Browse Our NASH and COVID-19 Coverage https://surfingnash.com/covid-19/

Drugs in development and diagnostics show promise but healthcare has far to go in identifying and treating patients in need.Professor Vlad Ratziu joins the Surfers to discuss Day Two's presentation. The day produced exciting presentations about drugs in development and suggestive findings of the role non-invasive tests and markers can play in predicting patient success. At the same time, other presentations focused on the challenges and opportunities involved in identifying and treating patients earlier in the course of the disease. The group explored issues in detail, leading to a longer conversation that was both thoughtful and rollicking. SPOILER ALERT: Four of the six Surfers made some form of reference to the Bible...Today's podcast is sponsored by Sonic Incytes Medical Corp., manufacturer of Velacur™. Velacur™ is the first handheld 3D liver health assessment tool that is fast, accurate, intelligent, and portable. A 25-minute discussion with George Aliphteras, CEO of Sonic Incytes and Dr. Michael Curry, lead author of poster FRI-050, which discusses Velacur, starts at 1:22:11 and runs ~26 minutes.

One day into the first-ever digital major conference, the Surfers review six presentations and one interactive session. A lot was learned, much of which did not fit into neat categories.The Surfers and guest Naim Alkhouri reviewed six presentations and one interactive session formally (points from other presentations crept in once or twice). Like the day itself, the group came to a few clear conclusions or consensus, except that AI/machine learning has a larger role to play going forward and that liver biopsy will play a pivotal role in the foreseeable future. This session runs well over an hour but is packed with information, insights, and questions.

The group discusses the plusses and minuses of digital conferences compared to traditional in-person events.Digital ILC starts Thursday, August 27. Donna Cryer, who oversaw the first Digital International NASH Day this year, and Stephen Harrison, who co-chairs NASH-TAG, discuss the factors that organizers consider when deciding whether to go digital and planning how to make it work. The discussion reveals some powerful benefits for a digital meeting in terms of how many people and which new groups can attend, as well as drawbacks in terms of spontaneity and events that build personal bridges and unusual ideas. You will never look at any kind of major meeting the same way after you listen to this.

The second part of the "What NASH patients want" series focuses on the future of healthcare apps and the role government agencies such as FDA, NIH, CMS, and EMEA can play in providing hope or increasing concern and anxiety based on their decisions and the consistency of their messages. In discussing apps, Fatty Liver Foundation President Wayne Eskridge, a trained electrical engineer, envisions a future when patients can receive continuous readings on key metrics using an implanted device that derives its power by burning the patient's glucose or fat, while the other Surfers lend their own thoughts and perspectives. In discussing the government, GLI President & CEO Donna Cryer and Wayne Eskridge discuss the need for the government to take an integrated approach to liver health. Specific points of action include two proposed pieces of legislation( the Liver Illness Visibility Act ad the Treat and Reduce Obesity Act) and the idea that all the relevant institutes within NIH would work on an integrated plan for liver disease. Finally, the Surfers discuss the need for the FDA to act from a place of transparency and patient engagement, particularly around the risk: benefit ratio for new medicines. Again, the other Surfers ask questions and share ideas. The music from Jeff Ramsdale provides a fantastic exit note.