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An in-depth look at Advanced Fibrosis due to NASH including Impact, Identification and Management

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Identifying Advanced Fibrosis

Noninvasive Tests (NITs)

Types of NITs:








Use of a Second NIT


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NASH, nonalcoholic steatohepatitis; NITs, noninvasive tests; NAFLD, nonalcoholic fatty liver disease; F0–F2, stage 0–2 fibrosis; F2, stage 2 fibrosis; F3, stage 3 fibrosis; F4, stage 4 fibrosis; AASLD, American Association for the Study of Liver Diseases; FIB-4, fibrosis-4; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; NFS, NAFLD fibrosis score; APRI, aspartate aminotransferase/platelet ratio index; US, United States; ELFTM, enhanced liver fibrosis; NICE, National Institute for Health and Care Excellence; TE, transient elastography; MRE, magnetic resonance elastography; kPa, kilopascal.

From a meta-analysis of 5 multinational cohorts (1,495 NAFLD patients with 17,452 PYF). Liver-related mortality was a secondary outcome and was defined by investigators.1

In a study of patients with histologically confirmed NASH, 48 of 217 (22%) patients with stage 3 fibrosis (F3) progressed to cirrhosis at median follow-up of 29 months. Analysis used data from two large, randomized, placebo-controlled, phase 2b studies of patients with F3 fibrosis and compensated cirrhosis due to NASH in which patients underwent biopsy at screening, Week 48, and Week 96.2

The study investigated interobserver agreement for scores of liver fibrosis in 65 biopsy specimens from patients with mixed liver disease etiologies. Concordance between three pathologists was analysed. Bivariate weighted κ for Ishak staging ranged from 0.57–0.67, and for NASH CRN staging ranged from 0.47–0.59.

FIB-4 test results are based on age, hence the accuracy of the test may vary according to age.

NFS test results are based on age, hence the accuracy of the test may vary according to age.

The study population included patients with histological findings consistent with NAFLD.

In patients with hepatitis C.

Identification of Advanced Fibrosis in patients NAFLD.1

False positives can arise from haemolysis, Gilbert syndrome, cholestasis and inflammation due to increased levels of α2-macroglobulin and haptoglobin.4

Moderate, F1–F2 and F2–bridging fibrosis with few septa.3

Moderate, categorized as mild–advanced fibrosis, ELFTM scores of 7.7–9.79.

Moderate is classified as patients with fibrosis staging of F2.

MRE image indicates Advanced Fibrosis (F3) – liver stiffness 6.1 kPa. Adapted from Venkatesh SK et al. J Magn Reson Imaging 2013;37:544–555

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US-PP-NAS-0813 02/23