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The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials.

Publication ,  Journal Article
Sanyal, AJ; Harrison, SA; Ratziu, V; Abdelmalek, MF; Diehl, AM; Caldwell, S; Shiffman, ML; Aguilar Schall, R; Jia, C; McColgan, B; Djedjos, CS ...
Published in: Hepatology
December 2019

Progression of nonalcoholic steatohepatitis (NASH) is incompletely characterized. We analyzed data on longitudinal changes in liver histology, hepatic venous pressure gradient (HVPG), and serum markers of fibrosis in 475 patients with NASH with bridging fibrosis (F3) or compensated cirrhosis (F4) enrolled in two phase 2b, placebo-controlled trials of simtuzumab. The trials were terminated after 96 weeks because of lack of efficacy, so data from treatment groups were combined. Liver biopsies and HVPG measurements (only for patients with F4 fibrosis) were collected at screening and at weeks 48 and 96. Patients were assessed for Ishak fibrosis stage, hepatic collagen content and alpha-smooth muscle actin (by morphometry), NAFLD Activity Score (NAS), and serum markers of fibrosis. Associations with progression to cirrhosis (in patients with F3 fibrosis) and liver-related clinical events (in patients with F4 fibrosis) were determined. Progression to cirrhosis occurred in 22% (48/217) of F3 patients, and liver-related clinical events occurred in 19% (50/258) of patients with cirrhosis. Factors significantly associated with progression to cirrhosis included higher baseline values of and greater increases in hepatic collagen content, level of alpha-smooth muscle actin, and Enhanced Liver Fibrosis score. Similar factors, plus lack of fibrosis stage improvement (hazard ratio, 9.30; 95% confidence interval, 1.28-67.37), higher HVPG at baseline, and greater increase in HVPG over time, were associated with an increased risk of liver-related clinical events in patients with cirrhosis. Disease progression was not associated with the NAS at baseline or changes in NAS during treatment after adjustment for fibrosis stage. Conclusion: In patients with advanced fibrosis due to NASH, the primary determinant of clinical disease progression is fibrosis and its change over time.

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Published In

Hepatology

DOI

EISSN

1527-3350

Publication Date

December 2019

Volume

70

Issue

6

Start / End Page

1913 / 1927

Location

United States

Related Subject Headings

  • Venous Pressure
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Hepatic Veins
  • Gastroenterology & Hepatology
 

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Sanyal, A. J., Harrison, S. A., Ratziu, V., Abdelmalek, M. F., Diehl, A. M., Caldwell, S., … Goodman, Z. (2019). The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials. Hepatology, 70(6), 1913–1927. https://doi.org/10.1002/hep.30664
Sanyal, Arun J., Stephen A. Harrison, Vlad Ratziu, Manal F. Abdelmalek, Anna Mae Diehl, Stephen Caldwell, Mitchell L. Shiffman, et al. “The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials.Hepatology 70, no. 6 (December 2019): 1913–27. https://doi.org/10.1002/hep.30664.
Sanyal AJ, Harrison SA, Ratziu V, Abdelmalek MF, Diehl AM, Caldwell S, et al. The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials. Hepatology. 2019 Dec;70(6):1913–27.
Sanyal, Arun J., et al. “The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials.Hepatology, vol. 70, no. 6, Dec. 2019, pp. 1913–27. Pubmed, doi:10.1002/hep.30664.
Sanyal AJ, Harrison SA, Ratziu V, Abdelmalek MF, Diehl AM, Caldwell S, Shiffman ML, Aguilar Schall R, Jia C, McColgan B, Djedjos CS, McHutchison JG, Subramanian GM, Myers RP, Younossi Z, Muir AJ, Afdhal NH, Bosch J, Goodman Z. The Natural History of Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: Data From the Simtuzumab Trials. Hepatology. 2019 Dec;70(6):1913–1927.
Journal cover image

Published In

Hepatology

DOI

EISSN

1527-3350

Publication Date

December 2019

Volume

70

Issue

6

Start / End Page

1913 / 1927

Location

United States

Related Subject Headings

  • Venous Pressure
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Hepatic Veins
  • Gastroenterology & Hepatology