Clinical Issues™ in Chronic Liver Disease

Faculty

Stephen A. Harrison, MD, FAASLD (Chair) 
Medical Director
Pinnacle Clinical Research
San Antonio, Texas
Visiting Professor of Hepatology
Radcliffe Department of Medicine
University of Oxford, UK
Oxford, England

Quentin M. Anstee, PhD, FRCP 
Professor of Experimental Hepatology and Deputy-Director of the Institute of Cellular Medicine
Newcastle University, United Kingdom
Honorary Consultant Hepatologist in the Liver Unit
Freeman Hospital
Newcastle upon Tyne, England

W. Ray Kim, MD 
Professor and Chief
Gastroenterology and Hepatology
Stanford University Medical Center
Stanford, California

Mark Sulkowski, MD 
Professor of Medicine
Medical Director of the Viral Hepatitis Center in the Divisions of Infectious Diseases and Gastroenterology/Hepatology
Johns Hopkins University School of Medicine
Baltimore, Maryland

Target Audience

The educational design of this activity addresses the needs of hepatologists, gastroenterologists, and other healthcare professionals involved in the treatment of patients with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or nonalcoholic steatohepatitis (NASH).

Program Overview

Three chronic diseases of the liver – HCV infection, HBV infection, and NASH – are commonly managed by gastroenterologists and hepatologists. Despite the availability of safe and effective treatments for HCV, many chronically infected patients remain unscreened, undiagnosed, and untreated.¹ People who inject drugs (PWID) represent a population in particular need of recognition, diagnosis, and treatment; the path to HCV elimination will never be clear without targeting PWID.² Managing events and comorbidities in patients with HBV can be challenging and requires careful monitoring and treatment selection, particularly for those patients who are coinfected with HCV or HIV.³ Although no medical cure is available for chronic HBV infection, clinicians must remain up to date on current and emerging treatments.^3,4 NASH along with its precursor NAFLD represent a growing burden that parallels the increasing prevalence of obesity and diabetes.⁵ The use of invasive diagnostic modalities is often not feasible, and not all noninvasive diagnostic strategies have been validated or are widely available, which can delay the diagnosis, thereby postponing implementation of necessary lifestyle modifications and treatment.^6,7 Clinicians who care for patients who have NASH are further challenged by the lack of US Food and Drug Administration (FDA)-approved therapies to treat this disease.⁶ Despite these clinical realities, it is important that clinicians suspect and recognize NAFLD/NASH as early in its course as possible, as is true with other chronic liver diseases, to slow progression to fibrosis and cirrhosis. During this Clinical Issues™ program, expert faculty will highlight and discuss challenges posed by these 3 chronic liver diseases, including strategies to eliminate HCV, even in the PWID population; current and future treatments of HBV; and updates on the pathophysiology and diagnosis of NASH.

References

1. Yehia BR, Schranz AJ, Umscheid CA, Lo Re V 3rd. The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis. PLoS One. 2014;9(7):e101554.
2. Alimohammadi A, Holeksa J, Thiam A, Truong D, Conway B. Real-world efficacy of direct-acting antiviral therapy for HCV infection affecting people who inject drugs delivered in a multidisciplinary setting. Open Forum Infect Dis. 2018;5(6):ofy120.
3. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599.
4. Anikhindi SA, Kumar A, Sharma P, Singla V, Bansal N, Arora A. Ideal cure for hepatitis B infection: The target is in sight. J Clin Exp Hepatol. 2018;8(2):188-194.
5. Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):E774.
6. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313(22):2263-2273.
7. Rinella ME, Sanyal AJ. Management of NAFLD: a stage-based approach. Nat Rev Gastroenterol Hepatol. 2016;13(4):196-205.

Educational Objectives

After completing this activity, the participant should be better able to:

• Consider recent trends in HBV epidemiology and treatment to optimize patient identification and management
• Identify approaches to overcome remaining barriers to HCV elimination
• Discuss data related to new pharmacologic agents under investigation for the treatment of NASH
• Evaluate current standards for diagnosis, staging, and monitoring in chronic liver disease

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Stephen A. Harrison, MD, FAASLD

Consultant/Independent Contractor: Akorn Pharmaceutical Company, Chronic Liver Disease Foundation (CLDF), Cirius Therapeutics, Civ., ConSynance Therapeutics, Inc., Corcept Pharmaceuticals Incorporated, CymaBay Therapeutics, Echosens, Galectin Therapeutics, Inc., GENFIT SA, Shenzen HighTide Biopharmaceutical Ltd., Histoindex Pte. Ltd., Innovate Biopharmaceuticals Inc, Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Metacrine, Inc., NGM Biopharmaceuticals Inc., Perspectum Diagnostics Ltd., Terns Pharmaceuticals, Inc., Viking Therapeutics Inc.; Grant/Research Support: Bristol-Myers Squibb, Cirius Therapeutics, Civ., Conatus Pharmaceuticals Inc., CymaBay Therapeutics, Galmed Pharmaceuticals Ltd., GENFIT SA, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., NGM Biopharmaceuticals Inc., Pfizer Inc.; Honoraria: AbbVie Inc., Alexion Pharmaceuticals Inc.; Speakers Bureau: AbbVie Inc., Alexion Pharmaceuticals Inc.; Stock Shareholder: Cirius Therapeutics, Civ., Galectin Therapeutics, Inc., GENFIT SA, Madrigal Pharmaceuticals, Inc., Metacrine, Inc.

Quentin M. Anstee, PhD, FRCP

Consultant/Independent Contractor: (performed on behalf of Newcastle University) Abbott Laboratories, Acuitas Medical Ltd., Allergan/Tobira, E3Bio Limited, Eli Lilly & Company Ltd., Galmed Pharmaceuticals Ltd., GENFIT SA, Gilead Sciences, Inc., Grünenthal, Imperial Innovations, Intercept Pharma Europe Ltd., Inventiva Pharma, Janssen Pharmaceuticals, Inc., Madrigal Pharmaceuticals Inc., MedImmune, LLC, NewGene, NGM Biopharmaceuticals, Inc., Novartis International AG, Novo Nordisk A/S, Pfizer Ltd., Raptor Pharma, Servier Laboratories; Grant/Research Support: Research Grant Funding: AbbVie Ltd., Allergan/Tobira, AstraZeneca plc, GlaxoSmithKline, Novartis International AG, Pfizer Ltd., Vertex Pharmaceuticals; Active Research Collaborations (including research supported through the EU IMI2 LITMUS Consortium*): AbbVie Ltd, Antaros Medical AB*, Allergan/Tobira, AstraZeneca plc, Boehringer Ingelheim International GMBH*, Ellegaard Göttingen Minipigs AS*, Eli Lilly & Company Ltd.*, Exalenz Bioscience Ltd.*, GENFIT SA*, GlaxoSmithKline, Intercept Pharma Europe Ltd.*, iXscient Ltd.*, Nordic Bioscience A/S*, Novartis International AG*, Novo Nordisk A/S*, One Way Liver Genomics SL*, Perspectum Diagnostics Ltd.*, Pfizer Ltd.*, Sanofi-Aventis Deutschland GMBH*, SomaLogic, Inc.*, Takeda Pharmaceuticals International AG*; Honoraria: Abbott Laboratories, Allergan/Tobira, Bristol-Myers Squibb, Clinical Care Options, Falk, GENFIT SA, Gilead Sciences, Inc., Kenes Group; Speakers Bureau: Abbott Laboratories, Allergan/Tobira, Bristol-Myers Squibb, Clinical Care Options, LLC, Dr Falk Pharma UK Ltd, GENFIT SA, Gilead Sciences, Inc., Kenes Group; Other/Royalty: Elsevier

W. Ray Kim, MD

Grant/Research Support: Gilead Sciences, Inc.

Mark S. Sulkowski, MD

Consultant/Independent Contractor: AbbVie Inc., Gilead Sciences, Inc., Merck & Co. Inc.; Grant/Research Support: (paid to Johns Hopkins) AbbVie Inc., Assembly Biosciences, Inc., Gilead Sciences, Inc., Proteus Digital Health, Inc.

The following planners and managers reported no financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Lindsay Borvansky, Andrea Funk, Liddy Knight, Jim Kappler, PhD, Gena Dolson

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Global and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the posttest and program evaluation. Your post-test will automatically be graded. If you successfully complete the posttest (score of 75% or higher), your statement of participation will be made available immediately. Click on the View Statement of Participation link and print the statement for your records. If you receive a score lower than 75%, you will receive a message notifying you that you did not pass the posttest. You will have 2 opportunities to pass the posttest.

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.