Rare Liver Disease Update: Nonalcoholic Steatohepatitis As the prevalence of NASH approaches that of Type 2 diabetes, new therapies to address chronic liver disease will soon reshape the treatment landscape for liver disease patients. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and the precursor to nonalcoholic steatohepatitis (NASH). NASH is a progressive form of NAFLD and can potentially lead to cirrhosis and the mortality associated with it. NASH has also quickly become a leading cause of liver transplantation and hepatocellular carcinoma.1 In the U.S., economic models estimate that 6.7 million adults live with NASH. 2017 saw 232,000 incident cases, and total estimated lifetime costs for NASH patients totaled $222.6 billion, with advanced-stage patients costing $95.4 billion.1
Lester Lachuk, Pharm.D., MBA VP, Corporate Pharmacy BlueCross BlueShield of Western New York
Cause and Pathogenesis of NASH Steatosis (infiltration of liver cells by fat) causes damage to the liver and leads to progressive liver fibrosis. NASH causes greater liver damage than isolated steatosis and often leads to liver-related illness and death. An analysis of over 8.5 million persons from 22 countries showed that over 80% of persons with NASH are overweight or obese, 72% have dyslipidemia, and 44% have received a diagnosis of Type 2 diabetes. Because of this, NASH is considered to be a hepatic form of metabolic syndrome, a systemic disorder associated with visceral adiposity.2 NASH is closely linked to liver fibrosis, which results in scarring. The level or degree of fibrosis is determined by biopsy and staged from F0 to F4. The stages of fibrosis scoring are as follows: F0 — no fibrosis, F1 — portal fibrosis without septa, F2 — portal fibrosis with few septa, F3 — bridging septa between central and portal veins, and F4 — cirrhosis. Studies show that a quarter of NASH patients have stage F2 fibrosis or higher when diagnosed.2 A certain level of fibrosis is expected in NASH patients, as it remains after liver wounds heal. Septa in the liver are made up of collagen and connecting tissue and reorganize the structure of the liver, decreasing its ability to function properly.
36 | Magellan Rx Report | Spring 2020
