Michael Charlton joins Jörn Schattenberg, Louise Campbell, and Roger Green for a far-reaching conversation that covers ways Rezdiffra is already impacting MASH patient treatment, exciting recent studies and broader issues in clinical trial recruitment.  

00:00:00 - Surf's Up: Season 5 Episode 11
Opening comments from the panel, including brief quotes taken directly from the episode. 

00:02:32 - Introduction
Opening comments (re)introducing listeners to Michael Charlton

00:04:34 - Groundbreakers
Each panelist shares one piece of good news from the previous week.

00:06:56 - Impact of Rezdiffra launch on Michael's clinic 
Michael hails Rezdiffra as "an amazing thing" in terms of its global impact. He goes on to discuss the challenges his clinic faces in properly defining the target F2/F3 patient. 

00:14:40 - Defining positive response and treatment futility 
In response to a question from Louise, Michael indicates that he will continue patients on Rezdiffra as long as they do not progress. 

00:19:44 - LiverRISK score
The conversation shifts to focus on progress in translational medicine. The first item Michael cites is LiverRIsk, which he terms "substantially superior" to other biomarkers. Next, he mentions his group's work on the microbiome and the challenges in translating items like these into clinically meaningful interventions.

00:23:15 - Low-dose aspirin as anti-MASH medicine 
Michael discusses the recent JAMA publication of a small RCT suggesting benefits from use of low-dose aspirin in biopsy-confirmed MASLD patients.  He and Jörn agree that while the sample size was small, the "highly promising" results might be worthy of discussion with patients.

00:26:29 - Jörn and Louise share their items of interest
Jörn discusses his excitement about the upcoming Innovations in SLD Think-Tank 2024 and its new format. Louise discusses a study indicating correlation between the Dietary Inflammation index score and kilopascal levels. 

00:33:27 – Questions about the Dietary Inflammation Index 
Louise and Jörn speculate on ways to incorporate this kind of result into multifactorial care. Michael asks whether alcohol figured in the index given that many MASH patients consume alcohol. 

00:35:38 - Roger on patient feedback
Roger asks how panelists feel about MD columnists recommending that MASH patients  "go to your doctor and ask for an ultrasound."  Michael and Louise agree that given how few patients are treated today, any such public acknowledgment is positive.

00:38:11 - Excitement and questions surrounding FGF-21s
Michael discusses the emerging excitement around the FGF-21 class. "emerging as highly potent" and asks questions its use and long-term value to patients. The group discusses adherence challenges with a q1w injectable therapy. 

00:41:26 Therapeutic models for MASH prescribing 
Roger asks whether prescribing for FGF-21s might align with an "oncology" model, with FGF-21 as induction drug and Rezdiffra as maintenance drug. Michael suggests that benefits from FGF-21s are likely to fade once therapy is discontinued. 

00:43:08 - Challenges in clinical trial recruitment and adherence
Jörn, Michael and Roger all agree on the growing challenge of keeping patients in the long-term clinical trials necessary to achieve hard outcomes.

00:47:24 - Closing question
Roger asks participants what they believe are exciting studies likely to come to light over the next three months. 

00:49:33 - Question of the Week
The question asks how much value old standard drugs like aspirin or pioglitazone are likely to bring to MASH or MASLD patient treatment.

00:50:22 - Business Report
This week's news on audience metrics, SurfingMASH sponsorship, spring events and this week's Vault conversation.