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The importance of ePRO to support NASH/NAFLD unmet clinical research and medical needs
NonAlcoholic SteatoHepatitis (NASH), now called Metabolic Dysfunction-Associated SteatoHepatitis (MASH), affects almost 115 million adults globally and is the most severe form of NonAlcoholic Fatty Liver Disease (NAFLD)/Metabolic Dysfunction-Associated Liver Disease (MASLD), conditions in which the liver builds up excessive fat deposits. The new nomenclature (MASH/MASLD) encompasses patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.
This disease is now considered a fast-growing epidemic and public health concern and is highly associated with obesity and diabetes. Through its association with fatigue, intense itching, abdominal swelling, bruising, and bleeding, and because of the significant behavioral consequences of the disease, this pathology is considered to have a significant impact on patients’ quality of life. At least 20% of those with NAFLD will develop NASH, and patients progressing to late-stage NASH often require complex, invasive, and expensive procedures such as liver transplant and bariatric surgery. Therefore, not only does an increasing number of NASH cases negatively impact an increasing number of patients’ quality of life, but it also has a significant economic impact for patients and their families, payers, and governments.
NAFLD also affects children, with ~10% of American children (6 million kids 2-19 years of age) developing the disease, which makes it the most common cause of chronic liver disease in children in the U.S. When progressing to NASH, the disease can lead to cirrhosis, liver cancer, and ultimately result in the need for liver transplantation.
Despite the strong medical need, there are very few approved treatments for NASH. Although many companies have attempted to develop drugs for the treatment of NASH, only a few candidates are in phase 3 development.
The fact that only 5% of the NAFLD/NASH protocols registered on ct.gov include PRO evaluation reveals a lack of patient-centric appraisals in the quest for treatments against the most common chronic liver disease, one of the most prevalent chronic conditions worldwide.
Even though NAFLD and NASH have a remarkable impact on patient quality of life, the number of clinical trials including PROs has barely increased in recent years (from 0 to only a small number of questionnaires), whereas the number of clinical trials has increased from 15 protocols in 2013 to 45 in 2019.
There is a clear need for more clinical research into NASH/NAFLD, and an associated need to include patient perspectives by adding ePROs to the clinical research protocols.
Including more ePRO in NASH trials will allow information beyond NAFLD-focused metrics to be recorded, and help the scientific community expand its knowledge and understanding of what matters most to NAFLD and NASH patients.
Symptoms of NASH can vary in nature and intensity, and so it is important to evaluate them regularly in a clinical trial. Widening the scope of the ePROs used will mean that areas where symptomatology matters for a given patient are not missed.
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Last update : 14 March 2024