S5 - E21.4 - The Updated MASLD CPG: Pharmacology And New Educational Needs

Surfing the MASH Tsunami

For most of this conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi discuss key issues related to pharmacology and prescribing choices. At the end, the focus shifts to the guidelines' overall benefits and some new kinds of education they call for.
The conversation starts with co-host Roger Green asking about key issues from the pharmacology section. Frank states that one benefit of the CPG is the clarity around the point that optimal treatment for a co-morbidity must involve thinking holistically about the liver in the overall metabolic context.
Elisabetta notes that while no drugs are efficacious for cirrhosis, the document does report that some drugs are safe for these patients, although sometimes with adjusted doses.
Frank concurs that the document provides guidance on managing patients with end-stage liver disease and also discusses how to manage cirrhosis and its various complications. Elisabetta notes that these can be the most difficult patients to screen for HCC because "the fat liver is sort of foggy."
This leads co-host Louise Campbell to discuss a point that arises frequently on this podcast: the positive value of simply stabilizing disease through medication and lifestyle.
Roger adds that many primary care physicians in the US find managing metabolic multi-comorbid patients confusing and frustrating. These guidelines, with an integrated vision of metabolic diseases and the idea that stabilization might be a sound strategy, simplified the perceived task.
Louise suggests that these guidelines "pinpoint...a role of the potential future" for nurses who can support the entire cardiometabolic syndrome. As she points out, even hepatology nurses are "not good at fatty liver disease." This document might drive a curriculum for such a specialization.