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In August 2023, CareNet published an academic paper “Clinical characteristics in patients with non-alcoholic steatohepatitis in Japan: a case–control study using a 5-year large-scale claims database” based on research conducted jointly with the University of Occupational and Environmental Health, which was published in BMJ.
*Related article: https://www.carenet.co.jp/english/featurednews2023_0920/
This paper concludes that in the daily treatment of patients with non-alcoholic steatohepatitis (NASH), considering sex and age differences, it is necessary to pay attention to the risk of malignant tumors, such as liver cirrhosis and liver cancer, and lifestyle comorbidities.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease affecting 20-30% of the world’s population. It is estimated that approximately 3–5% of the population suffers from NASH; however, studies overseas have shown that NASH is underdiagnosed owing to low rates of diagnosing biopsies* and of GL-recommended treatment prescriptions.
CareNet administered a descriptive questionnaire targeting member physicians involved in NAFLD/NASH treatment to clarify its current state in Japan. We received responses from 42 physicians (26 in gastroenterology, 11 in internal medicine, and 5 in surgery).
<Survey period>2023/12/1-12/6
*Mary E. Rinella, et al. Therap Adv Gastroenterol. 2016; 9(1): 4-12
・Physicians in the field are worried about treating a variety of patients with comorbidities, as there are no established treatments or drugs for NAFLD/NASH. Furthermore, they found it difficult to decide whether to perform a liver biopsy, suggesting that an alternative test method was needed.
・When NAFLD/NASH is diagnosed, in most cases, no therapeutic drugs are prescribed, or hepatic/biliary/digestive function improving agents are prescribed.
The average number of NAFLD patients in the past year treated by the physicians responding to the survey was 44, and the average number of NASH patients was 20.
[Table 1]
We asked open-ended questions regarding the symptoms and test results that led to NAFLD/NASH testing and diagnosis. Regarding NAFLD, the most common response was “abnormalities in blood test items” (85%), followed by “abnormal findings on image tests” (17%). Blood tests included AST, ALT, and γ-GTP, and imaging tests included ultrasound and CT. Similarly, for NASH, the most common response was “abnormalities in blood test items” (80%), followed by “abnormal findings on image tests” (15%). Blood test items such as for platelets and ferritin, as well as fibrosis markers FIB-4 and hyaluronic acid, were additionally listed.
[Table 2] Opportunities to promote testing and diagnosis of NAFLD
[Table 3] Opportunities to promote testing and diagnosis of NASH
We asked open-ended questions regarding the therapeutic drugs prescribed to patients diagnosed with NAFLD/NASH. Regarding NAFLD, the most common response was “Do not prescribe anything” (44%), followed by “hepatic/biliary/digestive function improving agents” (24%), and “hyperlipidemia treatment drugs” (12%). For NASH, “do not prescribe” and “hepatic/biliary/digestive function improving agents” were the most common responses (27% each), followed by “vitamin E preparations” (20%) and “SGLT2 inhibitors” (15%). Additionally, some respondents cited “oral nutritional supplements for liver failure,” “branched-chain amino acid preparations,” and “V2-receptor antagonists” as prescription drugs for patients with NASH. It was suggested that there are possibilities that treatment may be initiated after the symptoms have progressed.
[Table 4] Prescription intention at the time of NAFLD/NASH diagnosis
Finally, when we asked about their concerns regarding NAFLD/NASH diagnosis and treatment (free answers), the most common response (38%) was that “treatment methods and drugs have not been established,” followed by “regarding diagnosis and testing methods” (35%). Concerning the specific content of “regarding diagnosis and testing methods,” many respondents cited “difficulty deciding whether to perform a liver biopsy.” This suggests that there is a need not only for therapeutic drugs but also for testing methods that can replace liver biopsy.
[Table 5]
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