Im Gene Y, Asgharpour Amon, Aby Elizabeth S, Stine Jonathan G, Mellinger Jessica L, Luther Jay, Izzy Manhal, Haque Lamia, Lee Brian T, Cotter Thomas G, Sherman Courtney B, Jophlin Loretta L, Goel Aparna, Rice John, Chandna Shaun, Lizaola-Mayo Blanca, Chen Po-Hung, Singal Ashwani K, Bansal Meena B
Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons.
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
J Clin Gastroenterol. 2025 Jun 23. doi: 10.1097/MCG.0000000000002147.
Our aim was to perform a national survey of provider attitudes, practices, and knowledge regarding weight loss and MASLD medications in patients with MASLD.
While weight loss is a cornerstone in the management of metabolic dysfunction-associated steatotic liver disease (MASLD), FDA-approved medications for weight loss remain underutilized.
We conducted a survey before resmetirom approval of hepatology and gastroenterology providers practicing in 44 states. Surveys were sent to 747 providers with 304 complete responses (41%), of whom 260 (86%) work at a liver transplant center. While nearly all respondents (96%) believed that weight loss medications could benefit patients with MASLD, 77% have never/rarely prescribed them due to low comfort (81%). Among weight loss medication prescribers, glucagon-like peptide-1 (GLP-1) receptor agonists were preferred (66%). In contrast, 63% had prescribed off-label medications for MASLD in the past 12 months, most commonly vitamin E (30%) and GLP-1 receptor agonists (25%). The top reported barriers to prescribing weight loss medications were lack of training/unfamiliarity, cost/insurance coverage, and side-effects, which may be explained by low formal obesity education and lack of knowledge (only 33% of FDA-approved medications for weight loss were correctly identified by >50% of providers). Overall, there was reasonable provider-reported adherence to the 2023 AASLD practice guidance for MASLD.
This nationwide survey of hepatology and gastroenterology providers before resmetirom demonstrates that while off-label prescribing for MASLD was common, weight loss medication prescription rates remain very low due to low comfort possibly from insufficient education despite strong beliefs that they can benefit patients with MASLD.
我们的目的是对全国范围内医疗服务提供者关于非酒精性脂肪性肝炎（MASLD）患者减肥及相关药物的态度、实践和知识进行调查。
虽然减肥是非酒精性脂肪性肝炎（MASLD）管理的基石，但美国食品药品监督管理局（FDA）批准的减肥药物仍未得到充分利用。
我们在resmetirom获批之前，对在44个州执业的肝病学和胃肠病学医疗服务提供者进行了一项调查。共向747名医疗服务提供者发送了调查问卷，收到304份完整回复（41%），其中260人（86%）在肝移植中心工作。虽然几乎所有受访者（96%）都认为减肥药物对MASLD患者有益，但77%的人因信心不足（81%）从未/很少开具此类药物。在开具减肥药物的医疗服务提供者中，胰高血糖素样肽-1（GLP-1）受体激动剂是首选（66%）。相比之下，63%的人在过去12个月中为MASLD患者开具过非标签药物，最常见的是维生素E（30%）和GLP-1受体激动剂（25%）。报告的开具减肥药物的主要障碍是缺乏培训/不熟悉、成本/保险覆盖范围以及副作用，这可能是由于正规肥胖教育不足和知识欠缺所致（只有33%的FDA批准的减肥药物被超过50%的医疗服务提供者正确识别）。总体而言，医疗服务提供者报告的对2023年美国肝病研究学会（AASLD）MASLD实践指南的依从性较好。
这项在resmetirom获批之前对肝病学和胃肠病学医疗服务提供者进行的全国性调查表明，虽然为MASLD开具非标签药物很常见，但由于可能因教育不足导致信心不足，尽管坚信减肥药物对MASLD患者有益，但其处方率仍然很低。
