Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA.
Nat Rev Gastroenterol Hepatol. 2024 Oct;21(10):726-738. doi: 10.1038/s41575-024-00938-9. Epub 2024 Jun 4.
Since 1980, the cumulative effort of scientists and health-care stakeholders has advanced the prerequisites to address metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent chronic non-communicable liver disease. This effort has led to, among others, the approval of the first drug specific for metabolic dysfunction-associated steatohepatitis (MASH; formerly known as nonalcoholic steatohepatitis). Despite substantial progress, MASLD is still a leading cause of advanced chronic liver disease, including primary liver cancer. This Perspective contextualizes the nomenclature change from nonalcoholic fatty liver disease to MASLD and proposes important considerations to accelerate further progress in the field, optimize patient-centric multidisciplinary care pathways, advance pharmacological, behavioural and diagnostic research, and address health disparities. Key regulatory and other steps necessary to optimize the approval and access to upcoming additional pharmacological therapeutic agents for MASH are also outlined. We conclude by calling for increased education and awareness, enhanced health system preparedness, and concerted action by policy-makers to further the public health and policy agenda to achieve at least parity with other non-communicable diseases and to aid in growing the community of practice to reduce the human and economic burden and end the public health threat of MASLD and MASH by 2030.
自 1980 年以来,科学家和医疗保健利益相关者的共同努力推进了代谢功能障碍相关脂肪性肝病(MASLD)这一常见慢性非传染性肝病的治疗前提。这些努力促成了首个针对代谢功能障碍相关性脂肪性肝炎(MASH;以前称为非酒精性脂肪性肝炎)的特定药物的批准。尽管取得了重大进展,但 MASLD 仍然是晚期慢性肝病的主要原因,包括原发性肝癌。本文从非酒精性脂肪性肝病更名为 MASLD 的角度出发,提出了一些重要的考虑因素,以加速该领域的进一步进展,优化以患者为中心的多学科护理途径,推进药理学、行为学和诊断学研究,并解决健康差异问题。还概述了优化即将推出的 MASH 其他药物治疗药物的批准和可及性所需的关键监管和其他步骤。最后呼吁加强教育和意识,增强卫生系统的准备,以及决策者采取协调行动,进一步推进公共卫生和政策议程,至少与其他非传染性疾病保持平等,并帮助扩大实践社区,以减轻 MASLD 和 MASH 的人力和经济负担,并在 2030 年之前消除 MASLD 和 MASH 的公共卫生威胁。