Ndugga Nambi, Lightbourne Teisha G, Javaherian Kavon, Cabezas Joaquin, Verma Neha, Barritt A Sidney, Bataller Ramon
Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA.
Biochemistry, Departments of Medicine and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Open. 2017 Mar 22;7(3):e013620. doi: 10.1136/bmjopen-2016-013620.
Effective oral therapies for hepatitis B and C have recently been developed, while there are no approved pharmacological therapies for alcoholic and non-alcoholic fatty liver diseases (ALD and NAFLD). We hypothesise that fewer advances in fatty liver diseases could be related to disparities in research attention.
We developed the Attention-to-Burden Index (ABI) that compares the research activities during 2010-2014, and an estimate of disease burden of these 4 major liver diseases. The resulting ratio reflects either overattention (positive value) or inadequate attention (negative value) compared with disease burden. The mean research attention and disease burden were calculated from 5 and 6 different parameters, respectively. The efficacy rate of current pharmacological therapies was assessed from published clinical trials.
The mean research attention for hepatitis B and C was 31% and 47%, respectively, while NAFLD and ALD received 17% and 5%. The overall burden was 5% and 28% for hepatitis B and C, and 17% and 50% for NAFLD and ALD. The calculated ABI for hepatitis B and C revealed a +6.7-fold and +1.7-fold overattention, respectively. NAFLD received an appropriate attention compared with its burden, while ALD received marked inadequate attention of -9.7-fold. The efficacy rate of current pharmacological agents was 72% for hepatitis B, 89% for hepatitis C, 25% for non-alcoholic steatohepatitis and 13% for alcoholic hepatitis. Importantly, we found a positive correlation between the mean attention and the efficacy rate of current therapies in these 4 major liver diseases.
There are important disparities between research attention and disease burden among the major liver diseases. While viral hepatitis has received considerable attention, there is a marked inadequate attention to ALD. There is a critical need to increase awareness of ALD in the liver research community.
近期已研发出针对乙型和丙型肝炎的有效口服疗法，而酒精性和非酒精性脂肪性肝病（ALD和NAFLD）尚无获批的药物治疗方法。我们推测，脂肪性肝病进展较少可能与研究关注度差异有关。
我们制定了关注度-负担指数（ABI），用于比较2010年至2014年期间的研究活动以及这4种主要肝病的疾病负担估计值。所得比率反映了与疾病负担相比的过度关注（正值）或关注不足（负值）。平均研究关注度和疾病负担分别根据5个和6个不同参数计算得出。从已发表的临床试验中评估当前药物治疗的有效率。
乙型和丙型肝炎的平均研究关注度分别为31%和47%，而NAFLD和ALD分别为17%和5%。乙型和丙型肝炎的总体负担分别为5%和28%，NAFLD和ALD分别为17%和50%。计算得出的乙型和丙型肝炎的ABI分别显示出+6.7倍和+1.7倍的过度关注。与负担相比，NAFLD得到了适当关注，而ALD则受到了显著不足的关注，为-9.7倍。当前药物制剂的有效率分别为：乙型肝炎72%，丙型肝炎89%，非酒精性脂肪性肝炎25%，酒精性肝炎13%。重要的是，我们发现这4种主要肝病的平均关注度与当前治疗的有效率之间存在正相关。
主要肝病的研究关注度与疾病负担之间存在重要差异。虽然病毒性肝炎受到了相当多的关注，但对ALD的关注明显不足。肝脏研究界迫切需要提高对ALD的认识。
