Last dose of schnitzel before heading back stateside #ILC2019

@EASLedu @EASLnews Dr. Jacobson: evidence that GT3 patients with Y93x RAVs May increase their SVR12 by addition of ribavirin to #epclusa #ILC2019

@EASLedu @EASLedu Dr. Jacobson: most persons who fail initial #HCV DAA regimens have durable RAVs after treatment #IlC2019

@EASLnews @EASLedu Prof. lencioni: Microwave is probably equivalent to radio frequency ablation but probably will not expand applications for ablation even in expert hands (despite what your radiologist May tell you) #ILC2019

@EASLnews @EASLedu Prof. Mazzaferro: an AFP>1000 excludes patient from any surgery. Interesting how what defines a prohibitively high AFP is a moving target. 400? 1000? 2000? #ILC2019

@EASLedu @EASLnews Prof. Mazzaferro: HCC resection in a non cirrhotic NASH patient has a safety profile similar to that of a cirrhotic. More post-op complications #ILC2019

@Porphyria_Help @BPA_Porphyria @EASLedu @EASLnews $ALNY #givosaran meets reduction in composite annualized attack rate endpoint in ph3 ENVISION trial. 5/6 with baseline CKD worsened then returned to baseline. 1 had ALT>8xULN and d/c. 93/94 continue in open label phase #ILC2019

@EASLnews @EASLedu I consider all real world #HCV studies outside of marginalized and under treated populations such as #PWID as exercises in self promotion #ILC2019

@EASLnews @EASLedu a meta-analysis of “real world” glecaprevir-pibrentasvir studies shows that the drug is safe and effective. Who knew? #ILC2019

@EASLnews @EASLedu highlights from today’s #ILC2019 include potential new therapies for the porphyrias and the impact of post-transplant UDCA on #PBC patient graft survival

@EASLedu @EASLnews NAFLD is more than just liver disease so treatment needs to be multidisciplinary. We all agree but for a disease with a worldwide prevalence >1 billion, who foots the bill? #ILC2019

@EASLedu @EASLnews Prof. Ratziu: advise lean patients with NASH to avoid snacking (small frequent meals may increase steatosis) and exercise 15 min/day which increases hepatic fatty acid oxidation even in absence of wt loss #ILC2019

@EASLedu @EASLnews all this lean NASH existential debate calls into question the value of making a diagnosis of NASH at all as opposed to steatofibrosis: a much more useful and potentially actionable diagnosis #ILC2019

@EASLnews @EASLnews Prof Ratziu: lean NASH patients have abnormal visceral fat distribution as demonstrated in studies where waist-hip-ratio was elevated in these patients #ILC2019

@EASLedu @EASLnews Prof. Ratziu: “NASH can exist in lean patients but lean NASH doesn’t exist” meaning that secondary causes of NASH can be present in lean people or we may be diagnosing NASH in a transitional phase earlier in its natural history. #IlC2019

@EASLnews @EASLedu prof George: anaerobic/resistance exercise probably better than aerobic for NAFLD irrespective of wt loss #ILC2019

@EASLnews @EASLedu lean NAFLD patients eat more fat, CHO’s including high fructose and may exercise less. They just don’t get “fat”. Mediterranean diet may help this group too #ILC2019

@EASLedu @EASLnews lean NASH patients also have increased risk of extrahepatic adverse outcomes including CV disease and diabetes incidence #ILC2019

@EASLedu @EASLnews Prof. George: some evidence than lean NAFLD May confer more risk of liver related mortality than obese NAFLD #ILC2019

@EASLnews @EASLedu In Europe at least, can order a NASH genetic predisposition panel which includes PNPLA3, TM6SF7 and MBOAT7 as well as non steatotic genetic cholestatic diseases. Not entirely sure how this is actionable #ILC2019

@EASLedu @EASLedu PNPLA3 I148M is the most robust genetic predisposing factor of NASH and ASH. Over 50% Europeans are heterozygous and this may confer risk #ILC2019

@EASLnews @EASLedu NASH: fat, lean and everything in between...useful to think about SIBO, celiac disease, high fructose intake and kwashiorkor if pt not obese (I don’t systematically do this) #IlC2019

@EASLnews @EASLedu RIG-1 agonist inarigivir drops HBsAg titers in a non dose dependent manner (different host responses). 100% GT A are responders. Surprisingly high number of flares in placebo group #ILC2019

@EASLedu @EASLnews NLR concept if validated is interesting for someone like me who (almost) never uses steroids for alcoholic hepatitis #ILC2019

@EASLedu @EASLedu Prof. Forest: if you have severe alcoholic hepatitis & baseline Neutrophil to Lymphocyte ratio (NLR) >5, you have a greater chance of responding to corticosteroids #IlC2019

@EASLnews @EASLedu more REGENERATE clarifications from Prof. Younossi: average wt loss in OCA groups was 2 kg and no major differences in glycemic control but more data on this and predictors of response at @AASLDtweets #ILC2019

@EASLnews @EASLedu important to note that subset of F1 fibrosis patients with fibrosis progression risk factors were excluded from current REGENERATE analysis #ILC2019

@EASLedu @EASLnews cholesterol and HDL about on par with FLINT. Itching in 51% at 25 my dose peaking at 3 months and decreasing afterwards and led to discontinuation in 9%. No apparent cardiovascular or hepatic AE imbalance #ILC2019

@EASLnews @EASLedu REGENERATE improved ballooning and inflammation but less so steatosis which seems to partly be why endpoint of resolution of NASH wasn’t met #ILC2019

@EASLedu @EASLnews REGENERATE RCT of obeticholic acid vs. placebo more details: 80% completed month 18 biopsy, 60% female, most with NAS score>6. 13.3 vs 4.5% 2+ fibrosis stage improvement #ILC2019