Understanding MASH: An Examination of Progression and Clinical Outcomes by Disease Severity in the TARGET-NASH Database.

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2024-12-30 DOI:10.1007/s12325-024-03085-4

Rakesh Luthra, Aarth Sheth

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引用次数: 0

Abstract

Introduction: Metabolic dysfunction-associated steatohepatitis (MASH), the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), is linked to cardiometabolic risk factors such as obesity and type 2 diabetes (T2D). The rising prevalence of MASH and risk of hepatic and extra-hepatic complications emphasize the need for a better understanding of disease progression and associated outcomes. This study aimed to evaluate the incidence of, and demographic and clinical characteristics associated with, progression to MASH-related complications by disease severity in patients with non-cirrhotic MASH or MASH cirrhosis. Alignment between noninvasive tests (NITs) and biopsy-determined fibrosis stage was also assessed.

Methods: This analysis used data from the TARGET-NASH cohort that includes adults with MASH across academic and community sites in the United States. Patients with non-cirrhotic MASH or MASH cirrhosis were stratified by disease severity based on fibrosis stage or cirrhosis. Progression to MASH-related outcomes, including all-cause mortality, cirrhosis, and liver transplantation, was assessed.

Results: Among the 2378 patients included in this analysis, 48% had MASH cirrhosis. Incidence of all-cause mortality increased with disease severity from 0.14/100 person-months (100PM) at fibrosis stage 0-1 (F0-F1) to 2.02/100PM with compensated cirrhosis and 4.62/100PM with decompensated cirrhosis. Compared with patients with F0-F1, risk of progression to cirrhosis was higher in patients with F3 [hazard ratio (HR), 95% confidence interval (CI); 18.66, 10.97-31.73] and F2 (HR, 95% CI; 3.74, 2.00-6.98). Among those who progressed to MASH-related outcomes, 67.9% had T2D and 73.9% had hypertension. Vibration-controlled transient elastography showed better alignment with biopsy-determined fibrosis stage than Fibrosis-4 Index (FIB-4).

Conclusions: Progression to all-cause mortality in patients with MASH was significantly associated with the presence of higher fibrosis stage and cirrhosis. Cardiometabolic comorbidities such as T2D and hypertension were prevalent in patients with MASH progression. Early identification and management of MASH may mitigate disease progression and liver-related complications.

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了解MASH: TARGET-NASH数据库中疾病严重程度的进展和临床结果的检查。

代谢功能障碍相关脂肪性肝炎（MASH）是代谢功能障碍相关脂肪性肝病（MASLD）的进行性形式，与心脏代谢危险因素如肥胖和2型糖尿病（T2D）有关。MASH患病率的上升以及肝脏和肝外并发症的风险强调需要更好地了解疾病进展和相关结局。本研究旨在评估非肝硬化MASH或MASH肝硬化患者按疾病严重程度进展为MASH相关并发症的发生率、人口学和临床特征。非侵入性检查（NITs）和活检确定的纤维化分期之间的一致性也进行了评估。方法：本分析使用来自TARGET-NASH队列的数据，该队列包括美国学术界和社区中患有MASH的成年人。非肝硬化MASH或MASH肝硬化患者根据纤维化分期或肝硬化的疾病严重程度分层。评估进展到mash相关结果，包括全因死亡率、肝硬化和肝移植。结果：在本分析纳入的2378例患者中，48%为MASH肝硬化。纤维化0-1期（F0-F1）的全因死亡率为0.14/100人月（100PM），代偿性肝硬化为2.02/100PM，失代偿性肝硬化为4.62/100PM。与F0-F1患者相比，F3患者进展为肝硬化的风险更高[危险比（HR）， 95%可信区间（CI）；18.66, 10.97-31.73]和F2 (HR, 95% CI；3.74, 2.00 - -6.98)。在进展到mash相关结局的患者中，67.9%患有T2D， 73.9%患有高血压。振动控制的瞬时弹性成像显示，与纤维化-4指数（FIB-4）相比，活检确定的纤维化分期更符合。结论：MASH患者的全因死亡率进展与较高纤维化阶段和肝硬化的存在显著相关。心脏代谢合并症如T2D和高血压在MASH进展患者中普遍存在。早期识别和管理MASH可以减轻疾病进展和肝脏相关并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.