| Invited Lecture (JSH) |
| Fri. November 2nd 14:00 - 14:40 Room 12: Kobe International Conference Center Main Hall |
| Management of NAFLD： Present and future | |||
| Henry LY Chan | |||
| The Chinese University of Hong Kong | |||
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| Non-alcoholic fatty liver disease (NAFLD) is very prevalent in Asia; approximately 25% of the Asian population are suffering from NAFLD. Liver fibrosis is the most important independent predictor of liver related complication and mortality for NAFLD. Serum ALT level is not a good marker for NAFLD, while serum marker indexes have moderate performance to predict advanced liver fibrosis in a few histology series. Transient elastography by Fibroscan is the most well validated non-invasive assessment of liver fibrosis for NAFLD, and it has documented superior performance than serum marker indexes to predict advanced liver fibrosis. Controlled attenuation parameter (CAP) is a new feature of Fibroscan, which give an assessment on the severity of steatosis at the same time of liver stiffness measurement. For obese patients, and XL probe is designed to give a higher success rate of measurement than the traditional M probe. However, XL probe always give a lower reading than M probe at the same stage of liver fibrosis, and different liver stiffness measurement cutoffs should be applied for M and XL probes. As most NAFLD patients do not have advanced liver fibrosis, screening for NAFLD and liver fibrosis by Fibroscan seems most cost-effective in high risk patients. Diabetes mellitus is one key risk factor for liver fibrosis in NAFLD. In a screening program in Hong Kong, 70% of diabetes patient have fatty liver disease and 18% have advanced liver fibrosis. There is no approved pharmacological treatment for NAFLD at the present moment. Weight reduction by lifestyle modification remains the mainstay of treatment for NAFLD. Drugs that target at insulin resistance (metformin and thiazolidinediones) and oxidative stress (vitamin E) may improve liver biochemistry but do not have proven value in reduction of liver fibrosis. Many new agents with different molecular targets are under investigation for treatment of non-alcoholic steatohepatitis (NASH). The three drugs currently undergoing phase 3 development include obeticholic acid (farnesiod X nuclear receptor agonist), liraglutide (glucagon-like peptide-1 agonist) and elafibranor (dual peroxisome proliferator-activated receptor alpha and gamma agonist); all 3 drugs have shown promising results in resolution of NASH in phase 2 studies. Other agents that have just completed phase 2 studies are Cenicriviroc (dual C-C chemokine receptor type 2 and type 5 antagonist) and serlosertib (apoptosis signal-regulating kinase inhibitor). |
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