Non-alcoholic steatohepatitis (NASH) is an extreme form of non-alcoholic fatty liver disease and a condition for which currently there is no approved treatment.

The disease affects between 2 and 5 percent of the U.S. population, and many pharmaceutical companies are exploring possible treatments, with several in development.

In April 2018, InCrowd surveyed physicians to better understand their perspectives on treatments in development. In addition, our research also sought to understand comorbid conditions related to NASH.

We first conducted 30-minute MicroQual interviews with four physicians considered key opinion leaders on NASH. Then we used this feedback to develop a 5-minute quantitative MicroSurvey for 55 gastroentologists and hepatologists. These physicians are currently treating patients with NASH and are at least slightly knowledgeable about available treatments.

Ultimately, physicians feel that any effective treatment for NASH will need to be a combination regimen, versus a single agent, that helps resolve liver fibrosis, reduce liver inflammation, and interrupt the storage of fat in the liver. Ocaliva, currently on the market for a different indication and in Phase 3 trials for NASH, was mentioned the most frequently by physicians.

As expected, managing comorbid conditions was top of mind. Obesity emerged as the leading comorbid condition, with physicians reporting that 70 percent of their NASH patients have obesity.
This was followed by patients with dyslipidemia (55%), diabetes (48%), hypertension (47%), and cardiovascular disease (31%). Nearly 40 percent of physicians chose obesity as the most important comorbidity to treat first since it usually triggers other conditions followed by diabetes and then cardiovascular disease.

Physicians also said that about half of NASH patients require coordination with other physicians and specialists. Aside from other gastroenterologists and hepatologists, physicians put diabetologists and endocrinologists, to help with metabolic syndrome concerns, at the top of the list. Cardiologists were a little further down, to help manage hypertension and cardiovascular disease.