The Food and Drug Administration (FDA) recently approved the first and only medication to treat metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic fatty liver disease. The most common and deadliest liver disease in the U.S., MASH is known as a “silent killer” because patients are typically asymptomatic until the disease has progressed to advanced stages. When left untreated, MASH can result in cirrhosis, liver cancer or even decompensated cirrhosis, which requires a liver transplant. In addition, patients with MASH are more likely to develop cardiovascular disease and kidney disease.
The new drug, resmetirom, is an oral medication for patients who have a F2 or F3 fibrosis. Used long term in conjunction with a healthy diet and exercise, the medication alters the liver’s fat metabolism. Studies revealed that resmetirom reduced fat content and fibrosis in 23% to 30% of patients. Side effects with resmetirom included nausea and diarrhea.
“Having this medication is great news since MASH is the deadliest form of liver disease,” said Dr. Sonja Olsen, a board-certified gastroenterologist with Tampa General Hospital (TGH) Digestive Health Center.
Recently, the American Association of Clinical Endocrinology (AACE) and the American Association for the Study of Liver Diseases (AASLD) revised guidelines to recommend screening for MASH in the following patients:
- All patients with diabetes
- Patients with two or more cardiovascular risk factors, such as hypertension, diabetes, dyslipidemia and sleep apnea
- Patients with elevated liver chemistries
- Patients with hepatic steatosis found on imaging
Dr. Olsen is a strong advocate for patient screenings. “Because symptoms don’t surface until it’s too late, getting at-risk patients screened is critical,” she said.
Screening starts with an ultrasound or liver tests. From there, physicians can calculate the FIB-4 score, which has been shown to correlate with fibrosis. This is a simple formula using the patient’s age, AST, ALT and platelet count to help determine the likelihood of advanced fibrosis.
- Patients with a FIB-4 score greater than 1.5 should be referred for additional testing to determine the degree of liver scarring.
- Patients with stage 3 or 4 fibrosis need to be screened for liver cancer and establish care with a gastroenterologist or hepatologist.
As the only transplant hepatologist in both Palm Beach and Martin counties, Dr. Olsen offers the FibroScan, a noninvasive test that measures liver fat content. The FibroScan test is available at TGH Digestive Health Center locations in West Palm Beach and Palm Beach Gardens.
With more than a decade of experience in providing world-class digestive and liver care, Dr. Olsen specializes in liver disease and disorders, including those related to MASH. She is a member of the American Gastroenterological Association and the American Association for the Study of Liver Diseases.
Dr. Olsen’s vast expertise in treating all stages of liver disease and her unique credentials are why local primary care physicians and endocrinologists refer their patients with MASH to her.
For patient referrals, please call (561) 739-4TGH (4844) or visit TGHDigestiveHealth.com.