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CME / ABIM MOC

Targeting Nonalcoholic Steatohepatitis: An Update on Emerging Treatments

  • Authors: Scott Isaacs, MD, FACP, FACE
  • CME / ABIM MOC Released: 1/23/2023
  • Valid for credit through: 1/23/2024
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for diabetologists and endocrinologists, primary care physicians, and gastroenterologists.

The goal of this activity is for learners to be better able to assimilate data on emerging treatments for nonalcoholic steatohepatitis (NASH) and determine which patients may be candidates for these therapies.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Mechanism of investigational treatments for NASH in the context of disease pathology
    • Clinical trials of emerging NASH treatments
  • Have greater competence related to
    • Identifying patients who are at greatest risk for NASH


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Scott Isaacs, MD, FACP, FACE

    Adjunct Assistant Professor of Medicine
    Emory University School of Medicine
    Atlanta, Georgia
    The opinions expressed are those of Dr Isaacs and do not necessarily reflect the views of Emory University or Emory Healthcare. Dr Isaacs’s participation in this activity does not constitute or imply endorsement by Emory University or Emory Healthcare.

    Disclosures

    Scott Isaacs, MD, FACP, FACE, has no relevant financial relationships.

Editors

  • Kim Storck, PharmD

    Senior Director, Content Development, Medscape, LLC

    Disclosures

    Kim Storck, PharmD, has no relevant financial relationships.

  • Laura Jacob, MEd

    Senior Medical Education Director, Medscape, LLC

    Disclosures

    Laura Jacob, MEd, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC

Targeting Nonalcoholic Steatohepatitis: An Update on Emerging Treatments

Authors: Scott Isaacs, MD, FACP, FACEFaculty and Disclosures

CME / ABIM MOC Released: 1/23/2023

Valid for credit through: 1/23/2024

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References

  1. Younossi ZM, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2020;69:564-568.
  2. Alqahtani SA, et al. Poor awareness of liver disease among adults with NAFLD in the United States. Hepatol Commun. 2021;5:1833-1847.
  3. Tamaki N, et al. Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD. Nat Rev Endocrinol. 2022;18:55-66.
  4. Loomba R, et al. Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell. 2021;184:2537-2564.
  5. Younossi ZM, et al. Global epidemiology of nonalcoholic fatty liver disease - meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73-84.
  6. Younossi ZM, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019;71:793-801.
  7. Noureddin M, et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018;113:1649-1659.
  8. Duell PB, et al; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42:e168-e185.
  9. Cusi K, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28:528-562.
  10. Siddiqui MS, et al; NASH Clinical Research Network. Diagnostic accuracy of noninvasive fibrosis models to detect change in fibrosis stage. Clin Gastroenterol Hepatol. 2019;17:1877-1885.e5.
  11. Younossi Z, et al. The conundrum of cryptogenic cirrhosis: adverse outcomes without treatment options. J Hepatol. 2018;69:1365-1370.
  12. Promrat K, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51:121-129.
  13. Chalasani N, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328-357.
  14. Kim KS, et al. Beneficial effect of anti-diabetic drugs for nonalcoholic fatty liver disease. Clin Mol Hepatol. 2020;26:430-443.
  15. Ghosal S, et al. A meta-analysis of the effects of glucagon-like-peptide 1 receptor agonist (GLP1-RA) in nonalcoholic fatty liver disease (NAFLD) with type 2 diabetes (T2D). Sci Rep. 2021;11:22063.
  16. Liu L, et al. Association between different GLP-1 receptor agonists and gastrointestinal adverse reactions: a real-world disproportionality study based on FDA adverse event reporting system database. Front Endocrinol (Lausanne). 2022;13:1043789.
  17. Indaram MB, et al. Non-alcoholic fatty liver disease: an emerging cardiovascular risk enhancer. 2022. Accessed December 27, 2022. https://www.acc.org/latest-in-cardiology/articles/2022/07/13/14/58/non-alchoholic-fatty-liver-disease
  18. Gastaldelli A, et al. From NASH to diabetes and from diabetes to NASH: mechanisms and treatment options. JHEP Rep. 2019;1:312-328.
  19. Targher G, et al. The complex link between NAFLD and type 2 diabetes mellitus - mechanisms and treatments. Nat Rev Gastroenterol Hepatol. 2021;18:599-612.
  20. Vuppalanchi R, et al. Therapeutic pipeline in nonalcoholic steatohepatitis. Nat Rev Gastroenterol Hepatol. 2021;18:373-392.
  21. Sanyal AJ, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54:344‐353.
  22. Xu X, et al. Targeted therapeutics and novel signaling pathways in non-alcohol-associated fatty liver/steatohepatitis (NAFL/NASH). Signal Transduct Target Ther. 2022;7:287.
  23. ClinicalTrials.gov. A study of efinopegdutide (MK-6024) in participants with nonalcoholic fatty liver disease (NAFLD) (MK-6024-001). Accessed January 14, 2023. https://clinicaltrials.gov/ct2/show/NCT04944992
  24. Donnelly KL, et al. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115:1343-1351.
  25. ClinicalTrials.gov. A study of tirzepatide (LY3298176) in participants with nonalcoholic steatohepatitis (NASH) (SYNERGY-NASH). Accessed January 14, 2023. https://clinicaltrials.gov/ct2/show/NCT04166773
  26. Tilg H, et al. Insulin resistance, inflammation, and non-alcoholic fatty liver disease. Trends Endocrinol Metab. 2008;19:371-379.
  27. Jiang L, et al. Farnesoid X receptor (FXR): structures and ligands. Comput Struct Biotechnol J. 2021;19:2148-2159.
  28. Panzitt K, et al. Recent advances on FXR-targeting therapeutics. Mol Cell Endocrinol. 2022;552:111678.
  29. Sanyal AJ, et al. Topline results from a new analysis of the REGENERATE trial of obeticholic acid for the treatment of nonalcoholic steatohepatitis. Presented at: American Association for the Study of Liver Diseases; November 4-8, 2022; Washington, DC. Abstract 5008. https://www.aasld.org/sites/default/files/2022-11/2022%20Late%20Breaking%20Abstracts%20rev2.pdf
  30. Younossi ZM, et al; REGENERATE Study Investigators. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019;394:2184-2196.
  31. ClinicalTrials.gov. Study Evaluating the efficacy and safety of obeticholic acid in subjects with compensated cirrhosis due to nonalcoholic steatohepatitis (REVERSE). Accessed January 14, 2023. https://clinicaltrials.gov/ct2/show/NCT03439254
  32. Lange NF, et al. PPAR-targeted therapies in the treatment of non-alcoholic fatty liver disease in diabetic patients. Int J Mol Sci. 2022;23:4305.
  33. ClinicalTrials.gov. A phase 3 study evaluating long-term efficacy and safety of lanifibranor in adult patients with (NASH) and fibrosis 2 (F2)/fibrosis 3 (F3) stage of liver fibrosis (NATiV3). Accessed January 14, 2023.https://clinicaltrials.gov/ct2/show/NCT04849728
  34. Kannt, A. et al. Activation of thyroid hormone receptor-β improved disease activity and metabolism independent of body weight in a mouse model of nonalcoholic steatohepatitis and fibrosis. Br J Pharm. 2021;178:2412–2423.
  35. ClinicalTrials.gov. A phase 3 study to evaluate the safety and biomarkers of resmetirom (MGL-3196) in non alcoholic fatty liver disease (NAFLD) patients (MAESTRO-NAFLD1). Accessed January 14, 2023. https://clinicaltrials.gov/ct2/show/NCT04197479
  36. McLeod K, et al. Galectin-3 regulation of wound healing and fibrotic processes: insights for chronic skin wound therapeutics. J Cell Commun Signal. 2018;12:281-287.
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