This thing is ded…

@bsky.app I don’t know that I feel comfortable handing out very personal information to verify I’m an adult.
Please find a better way or I’m moving on.

Effective rx for severe Alcohol Associated Steatohepatitis #ASH is the greatest unmet need in #hepatology

It fills hospital beds & kills people in their prime

Yet…

A cursory look shows >40 clinical stage ph2/3 #MASH studies vs (maybe) 3 for ASH

We need to get our priorities straight…

#liversky

Thrilled to be at the @davaoncology.bsky.social summit on GI malignancies. I had the pleasure of speaking on the topics of the intersection of incretins and cancer as well as the declining incidence of #HCC

#liversky

Many patients had been on Ocaliva for years with a good response and tolerability.

Since 2016, intercept invested a significant amount of time, effort and resources towards elevating patient voices, raising awareness and bridging the knowledge gap.

Let’s at least give them credit for this.

The evidence presented by regulators leaves me unconvinced that presumed OCA hepatotoxicity is a systemic and pervasive issue that requires decisive action.

Fortunately, we now have other better tolerated drugs that are effective in second line for persons living with PBC.

The voluntary withdrawal of Ocaliva by Intercept for PBC is not a cause for celebration.

It is certainly not an action that enhances the safety of the American public by protecting it from a nefarious, hepatotoxic drug.

Ocaliva is not troglitazone or bromfenac.

#liversky

More great news this time for European patients living with #MASH with F2/F3 fibrosis with the approval of #Rezdiffra™ (#resmetirom) by the @ema.europa.eu

Rezdiffra is included in the @easlnews.bsky.social
guidelines as FL therapy and is the first approved MASH medication in the EU.

#liversky

More #efruxifermin data this time in #MASH F2/F3 fibrosis @ 96 weeks

✅ Efficacy w/ dose dependent response (sort of) and NITs consistent
↔️ not crazy about mITT though it is mentioned no paired bx= non responders
⬇️ dose dependent reduction in bone mineral density

#liversky

Having options in the management of a complex disease with multiple nutritional, metabolic, environmental & genetic inputs is important.

There are potential synergies between drugs with different mechanisms of action (MOA). I anticipate at least 5 more approvals with novel MOAs in the coming 5 y

The @fda.gov just approved @novonordisk.bsky.social #wegovy on an accelerated path for #MASH F2/F3 fibrosis

We now have 2 approved drugs with different MOA and that’s great news for patients. I anticipate at least 5 more approvals in the next 5 years.

#liversky

Having options in the management of a complex disease with multiple nutritional, metabolic, environmental & genetic inputs is important.

A real question that will be answered soon is how will payers react?

#semaglutide now has 5 approved indications. Payers reliably only cover one.

#liversky

Since #orforglipron is in the news, a helpful timeline:

There isn't a PDUFA (Prescription Drug User Fee Act) date set yet but @elilillyandcompany.bsky.social
has indicated they plan to submit for @US_FDA approval in Q3/4 2025

If approved, it could be available in Q4 2025 or 2026

#liversky

Madrigal obtains rights to CSPC Pharmaceutical’s SYH-2086 Madrigal Pharmaceuticals Inc. and CSPC Pharmaceutical Group Ltd. have entered into an exclusive global license agreement for CSPC’s SYH-2086, a preclinical oral small-molecule glucagon-like peptide-1 ...

#Madrigal gains rights to CSPC’s #SYH-2086 as potential #MASH combo treatment.

SYH-2086 is an #orforglipron derivative (see last post)

An oral GLP-1 agonist + THR-B agonist would be an interesting combo that addresses broader cardiometabolic risk factors.

#liversky

Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist, in Early Type 2 Diabetes - PubMed In adults with early type 2 diabetes, orforglipron significantly reduced the glycated hemoglobin level over a period of 40 weeks. (Supported by Eli Lilly; ACHIEVE-1 ClinicalTrials.gov number, NCT05971...

The second @nejm.org #orforpligron paper is out.

There is no doubt that Oral GLP-1s are coming.

For #MASH, discontinuation rates will matter. 4-8% in T2DM (44w) vs. 10-17% in obesity (36w) which always seems higher.

How might our patients fare?

#liversky

We are looking forward to rolling out dual cut off reporting for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) which will aid in more accurately ruling in and out clinically significant portal hypertension (CSPH) and enhance clinical trial capability.
#liversky

Jaume Bosch

No one, and I mean no one, made more seminal contributions to the measurement, interpretation & clinical applications of HVPG, the prognostic impact of CSPH and its rx.

Truly in the pantheon of all time greatest hepatologists and a kind, generous person on top.

RIP

#liversky

Last 24 hours in #beirut.
Anise cookies, Arabic coffee and traditional cups

This evening, @ohioliver.bsky.social awarded its inaugural Liver Champion award to Dr. Anthony Post “for decades of excellence, advocacy and commitment to northeast Ohioans with liver disease”
Thanks to all who joined us and made this a memorable event!
#liversky

Join @ohioliver.bsky.social on May 14 at 630 pm at the Embassy suites hotel in Independence OH for Tavill Liver rounds. We will be honoring Dr. Anthony Post with our inaugural liver champion award!
#liversky

🇬🇧 CALIBRE trial – D. Tripathi at #EASL2025

RCT: carvedilol vs VBL for 1º prevention in cirrhosis
🟰 No difference in bleeding or survival at 12 months
💊 Carvedilol safe, simpler & cost-effective
📉 Follow-up limited (12 mo), but extension planned
⚠️ Underpowered due to COVID

Highlights of @docberza.bsky.social talk on NITs @easlnews.bsky.social #easlcongress
We need to use @bavenocoop.bsky.social
dual stiffness cutoffs more often and u suspect this is the way of the future.
#liversky

Exhibitor booths are not usually meeting highlights but this is an exception. Kudos to @boehringerglobal.bsky.social
on this artistic rendition on the theme of liver health and disease @easlnews.bsky.social #EASLCongress
#livertwitter

University President Who Shut Down D.E.I. Efforts Is Recruited to Florida

I would venture to say that for @umich.edu this was a swing and a miss.
Always be weary of people who chase after an even more outrageous compensation than the one they are getting and are willing to change jobs like they change underwear…

Amsterdam bound to attend @easlnews.bsky.social #easlcongress
Looking forward to learning, connecting with old friends and making new ones!
#liversky

Out of all current FDA approvals: DM, overweight/obese, death RR in CV disease, delay in renal disease progression in CV/DM and OSA…

PAYERS ONLY RELIABLY COVER DM

Are PBMs suddenly going to loosen up their purses because there is a #MASH indication?

I’ll believe it when I see it…

#liversky

Phase 3 Trial of Semaglutide in Metabolic Dysfunction–Associated Steatohepatitis | NEJM Semaglutide, a glucagon-like peptide-1 receptor agonist, is a candidate for the treatment of metabolic dysfunction–associated steatohepatitis (MASH). In this ongoing phase 3, multicenter, randomize...

The full ESSENCE dataset of #semaglutide in #MASH is published. The results at 72 weeks look great. Additional cardiometabolic benefits are definitely a plus.
An sNDA is said to be forthcoming in Q3/4.
#liversky

A delightful assortment of Lebanese mezze at Sky Lounge Parma today!

Early returns on my #resmetirom #rezdiffra #MASH patients at 1 year. So far 7/8 patients reasessed with LSM have a 30% or greater reduction. Hopefully we start getting some real world data to complement the open label trial.
#liversky

Because all the cool kids are doing it!
I look like an older version of me plus some cosmetic surgery.
#liversky