retatrutide

This conversation between Scott Friedman, Laurent Castera, Louise Campbell and Roger Green covers a pivotal session on the new MASLD nomenclature, plus what the panelists found exciting and important about the developing class of triple agonists, at TLM 2023. 

This conversation starts with Roger stepping gently into the topic of the new MASLD nomenclature by discussing a Saturday morning session chaired by Maru Rinella and Meena Bansal. The session took a broad, fairly detailed view of progress in knowledge and implementation of this nomenclature. Roger's point: two of the three obvious potential downsides to the new nomenclature are now rendered resolved. First, George Makar of FDA stated that the agency now uses the terms “MASH” and “NASH” or “MASLD” and “NAFLD” interchangeably, which means that the nomenclature will cause no delays or rework around drug and device clinical trials. Second, Quentin Anstee and Arun Sanyal reported from the LITMUS and NIMBLE databases that the patient overlap when mapping against the two definitions was 95-98%, which means there should be no dispute around the impact on how we define patient populations. In this regard, Roger notes that Gregory Gores, editor-in-chief of Hepatology, said the journal believes this issue is over and will not accept more publications on the subject. 

The third item is the perceived stigma around the word “fat.” Roger quotes NASH kNOWledge founder and patient advocate Tony Villiotti, who points out that while we may describe a specific medical event as a myocardial infarction, the doctor still tells the patient "You had a heart attack." Similarly, the concept of “fat on the liver” will be essentially to explain what is going on to the patient, whatever the nomenclature says. This leads Laurent to discuss the paper on stigma presented at the conference which suggests that "fatty liver" is far less stigmatizing in general than "obesity" or "diabetes," and some specific nuances of the paper. When he is done, Scott and Roger comment on vastly different moments in history and regions in the world where obesity was actually considered a sign of something positive. 

This entire discussion leads Scott to remember a presentation on Eli Lilly's triple agonist retatrutide and the remarkable impact this class of drugs is likely to have on how we manage obesity, diabetes and liver disease. Roger notes that Altimmune and Merck/Hanmi have similar agents in development. He goes on to note that these drugs demonstrate levels of weight loss found with bariatric surgery and asks Laurent and Scott whether they believe the drugs will have impact similar  to surgery. Both say it is too early to tell. Louise follows this by mentioning a study showing that allied health professionals are proficient at motivating patients to lose weight, maintain that loss, and do so in healthy ways.

Roger's wrap-up question asks what will be different at TLM2024 next year in San Diego. You’ll have to listen to hear the answers.