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Allen AM, Charlton M, Cusi K, Harrison SA, Kowdley KV, Noureddin M, Shubrook JH. Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. Postgrad Med 2024; 136:229-245. [PMID: 38465573 DOI: 10.1080/00325481.2024.2325332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing worldwide. Primary care providers play a critical role in the screening, diagnosis, and management of MASLD and/or metabolic dysfunction-associated steatohepatitis (MASH), though they can face challenges in this setting, particularly where healthcare resources are limited and barriers to care exist. To address these challenges, several guidelines have been developed to provide evidence-based recommendations for the clinical assessment and management of patients with MASLD/MASH. AIMS To provide a unified, simple-to-understand, practical guide for MASLD screening, diagnosis, and management based on current guideline recommendations, for use by primary care providers in daily practice. METHODS Evidence-based recommendations from several international guidelines were summarized, focusing on the similarities and differences between them. RESULTS Recommendations are broadly aligned across the guidelines, but several key differences are evident. Practical guidance is provided on screening, identifying target populations for risk stratification, initial evaluation of individuals with suspected MASLD, surveillance, risk stratification and referral, as well as approaches to the management of MASLD and associated comorbidities, with specific considerations for the primary care setting. CONCLUSIONS Primary care providers are ideally placed to identify at-risk individuals, implement evidence-based interventions to prevent the development of fibrosis and cirrhosis, and effectively manage comorbidities. Equipping primary care providers with the necessary knowledge and tools to effectively manage MASLD/MASH may help to improve patient outcomes and reduce the burden of liver disease.
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Affiliation(s)
- Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michael Charlton
- Transplantation Institute, University of Chicago Medicine, Chicago, IL, USA
| | - Kenneth Cusi
- Division of Endocrinology, University of Florida, Gainesville, FL, USA
| | | | - Kris V Kowdley
- Liver Institute Northwest and Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Mazen Noureddin
- Houston Research Institute and Houston Liver Institute, Houston, TX, USA
| | - Jay H Shubrook
- Department of Clinical Sciences and Community Health, Touro University California, Vallejo, CA, USA
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, VanderWel B, Kedia P, Ujiki MB, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Practice patterns and outcomes of endoscopic sleeve gastroplasty based on provider specialty. Endosc Int Open 2024; 12:E253-E261. [PMID: 38415023 PMCID: PMC10898995 DOI: 10.1055/a-2251-3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is performed in clinical practice by gastroenterologists and bariatric surgeons. Given the increasing regulatory approval and global adoption, we aimed to evaluate real-world outcomes in multidisciplinary practices involving bariatric surgeons and gastroenterologists across the United States. Patients and methods We included adult patients with obesity who underwent ESG from January 2013 to August 2022 in seven academic and private centers in the United States. Patient and procedure characteristics, serious adverse events (SAEs), and weight loss outcomes up to 24 months were analyzed. SPSS (version 29.0) was used for all statistical analyses. Results A total of 1506 patients from seven sites included 235 (15.6%) treated by surgeons and 1271 (84.4%) treated by gastroenterologists. There were no baseline differences between groups. Gastroenterologists used argon plasma coagulation for marking significantly more often than surgeons ( P <0.001). Surgeons placed sutures in the fundus in all instances whereas gastroenterologist placed them in the fundus in less than 1% of the cases ( P <0.001>). Procedure times were significantly different between groups, with surgeons requiring approximately 20 minutes more during the procedure than gastroenterologists ( P <0.001). Percent total body weight loss (%TBWL) and percent responders achieving >10 and >15% TBWL were similar between the two groups at 12, 18, and 24 months. Rates of SAEs were low and similar at 1.7% for surgeons and 2.7% for gastroenterologists ( P >0.05). Conclusions Data from a large US cohort show significant and sustained weight loss with ESG and an excellent safety profile in both bariatric surgery and gastroenterology practices, supporting the scalability of the procedure across practices in a multidisciplinary setting.
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Affiliation(s)
- Khushboo Gala
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Vitor Brunaldi
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
- Gastroenterology department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Daniel Maselli
- GI, True You Weight Loss Georgia LLC, Cary, United States
| | | | - Prashant Kedia
- Gastroenterology, Methodist Dallas Medical Center, Dallas, United States
| | - Michael B Ujiki
- NorthShore Center for Simulation and Innovation, NorthShore University Health Systems, Evanston, United States
| | - Erik Wilson
- Surgery, University of Texas McGovern Medical School, Houston, United States
| | - Eric J. Vargas
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Andrew C Storm
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
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Stanford FC. A new era in obesity management. Nat Rev Gastroenterol Hepatol 2024; 21:80-81. [PMID: 38092859 PMCID: PMC10909397 DOI: 10.1038/s41575-023-00887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
2023 was the most memorable year on record for obesity. The American Academy of Pediatrics recognized the complex, multifactorial nature of obesity and the broad range of treatments necessary to care for pediatric patients. The first-ever triple agonist and high-potency oral GLP1 agonist was introduced with unprecedented results.
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Affiliation(s)
- Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA.
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Levi J, Fairhead C, Hill A. Intersections between HIV and obesity in emerging economies. Curr Opin HIV AIDS 2024; 19:35-44. [PMID: 37922195 DOI: 10.1097/coh.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW HIV epidemics are increasing in many emerging economy countries, whilst the very process of 'economic emergence' is obesogenic. Annual deaths related to obesity and overweight are now four times more than for HIV globally. We describe the intersections between HIV and obesity in emerging economies, and highlight potential mitigation options, including antiobesity medications (AOMs), which are safe and effective, but inaccessibly priced. RECENT FINDINGS We summarize what is known about weight-change in HIV and review strategies including public health policies and clinical interventions for emerging economy countries to fight obesity. We also illustrate the landscape from a selection of 'emerging economy' countries with available data from UNAIDS, World Bank and World Obesity Federation to visualize the developing challenges faced. AOM course prices are high in many countries, but could be manufactured and sold profitably for much less. We present lessons from the early HIV/AIDS movements on how to improve access and pricing for AOMs for people with HIV with obesity in emerging economy countries. SUMMARY We illustrate the complex intersectional issues that 'emerging economy countries' may experience, with a 'double burden' of increasing HIV and obesity epidemics, and explore potential mitigation options, focussing on AOM access and pricing.
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Affiliation(s)
- Jacob Levi
- Charité University Hospital, Berlin Institute of Tropical Medicine and International Health, Südring 2-3, Berlin, Germany
| | - Cassandra Fairhead
- Charité University Hospital, Berlin Institute of Tropical Medicine and International Health, Südring 2-3, Berlin, Germany
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, UK
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Kendrick KN, Bode Padron KJ, Bomani NZ, German JC, Nyanyo DD, Varriano B, Tu L, Stanford FC. Equity in Obesity Review. Endocrinol Metab Clin North Am 2023; 52:617-627. [PMID: 37865477 DOI: 10.1016/j.ecl.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Obesity disproportionately affects racial and ethnic minoritized populations and those of lower socioeconomic status. Similarly, disparities exist in the development of its downstream consequences, such as type 2 diabetes and hypertension. The causes of these disparities are multifactorial and are influenced by structural factors such as segregation and healthcare access, and individual-level factors such as weight stigma. Interventions to decrease disparities in obesity should consider macro-level, community, and individual-level factors that might reduce disparities and improve equity in obesity care. Clinicians must also recognize the chronic nature of obesity, and how bias and stigma may impact patient care.
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Affiliation(s)
- Karla N Kendrick
- Beth Israel Lahey Health, Winchester Hospital Weight Management Center.
| | - Kevin J Bode Padron
- Massachusetts General Hospital Neuroendocrine and Pituitary Tumor Clinical Center, 100 Blossom Street, Cox Building Suite 140, Boston, MA 02114, USA; Duke University School of Medicine, DUMC 2927, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, USA
| | - Nichola Z Bomani
- Massachusetts General Hospital Neuroendocrine and Pituitary Tumor Clinical Center, 100 Blossom Street, Cox Building Suite 140, Boston, MA 02114, USA; Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jashalynn C German
- Duke Division of Endocrinology, Metabolism, and Nutrition, 200 Trent Drive, Baker House, DUMC Box 3021, Durham, NC 27710, USA
| | - Dennis D Nyanyo
- Beth Israel Lahey Health, Winchester Hospital Weight Management Center; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Harvard Kennedy School of Government, 79 John F. Kennedy Street, Cambridge, MA 02138, USA
| | - Brenda Varriano
- Mass-General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Lucy Tu
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA, USA; Department of History of Science, Harvard University, 1 Oxford St #371, Cambridge, MA, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital MGH Weight Center, 50 Staniford Street, Suite 430, Boston, MA 02114, USA
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BouSaba J, Vosoughi K, Dilmaghani S, Prokop LJ, Camilleri M. Pharmacogenetic interactions of medications administered for weight loss in adults: a systematic review and meta-analysis. Pharmacogenomics 2023; 24:283-295. [PMID: 36999540 PMCID: PMC10152409 DOI: 10.2217/pgs-2022-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
Aim: To analyze roles of single nucleotide variants (SNVs) on weight loss with US FDA-approved medications. Materials & methods: We searched the literature up until November 2022. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Results: 14 studies were included in qualitative analysis and seven in meta-analysis. SNVs in CNR1, GLP-1R, MC4R, TCF7L2, CTRB1/2, ADIPOQ, SORCS1 and ANKK1 were evaluated relative to weight loss with glucagon-like peptide-1 agonists (13 studies) or naltrexone-bupropion (one study). CNR1 gene (rs1049353), GLP-1R gene (rs6923761, rs10305420), TCF7L2 gene (rs7903146) were associated with weight loss in at least one study involving glucagon-like peptide-1 agonist(s). The meta-analysis did not identify any consistent effect of SNVs. Conclusion: Pharmacogenetic interactions for exenatide, liraglutide, naltrexone-bupropion and weight loss were identified, but the directionality was inconsistent.
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Affiliation(s)
- Joelle BouSaba
- Clinical Enteric Neuroscience Translational & Epidemiological Research (CENTER), Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kia Vosoughi
- Clinical Enteric Neuroscience Translational & Epidemiological Research (CENTER), Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Saam Dilmaghani
- Clinical Enteric Neuroscience Translational & Epidemiological Research (CENTER), Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Larry J Prokop
- Library, Public Service Department, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational & Epidemiological Research (CENTER), Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Gulati M. President's page: The re-emergence of prevention in the forefront of cardiology. Am J Prev Cardiol 2023; 13:100458. [PMID: 36619174 PMCID: PMC9805952 DOI: 10.1016/j.ajpc.2022.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
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Levi J, Wang J, Venter F, Hill A. Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment. Obesity (Silver Spring) 2023; 31:1270-1279. [PMID: 36815242 DOI: 10.1002/oby.23725] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Novel antiobesity treatments are highly effective in recent clinical trials. Access to these medications is needed to supplement lifestyle and surgical interventions for millions living with obesity worldwide, but high prices are limiting. This study aimed to review current treatment costs and calculate potential estimated minimum prices (EMPs). METHODS The authors searched national drug price databases across various countries for orlistat, naltrexone-bupropion, topiramate-phentermine, liraglutide, semaglutide, and tirzepatide. EMPs for antiobesity medications were calculated using established methodology, using active pharmaceutical ingredients (API) from the Panjiva database. EMPs were calculated per 30-day course and include costs of active pharmaceutical ingredients, excipients, formulation, taxation, and 10% profit margin. RESULTS National prices of antiobesity medications were significantly higher than calculated EMPs. Semaglutide 30-day course prices ranged from $804 (United States) to $95 (Turkey) while the EMP was $40. Liraglutide prices ranged from $1418 (United States) to $252 (Norway) while the EMP was $50. Some oral treatments could be generically manufactured at very low costs per course ($7 for orlistat; $5 for phentermine/topiramate combination tablets), while naltrexone/bupropion was more expensive ($54). CONCLUSIONS This study shows that certain weight loss treatments can be manufactured and sold profitably at low costs, but prices currently range widely between countries, limiting access for those in need.
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Affiliation(s)
- Jacob Levi
- Intensive Care Medicine, Royal Free Hospital NHS Trust, London, UK
| | - Junzheng Wang
- Medical Sciences Office, Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, UK
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Enright C, Thomas E, Saxon DR. An Updated Approach to Antiobesity Pharmacotherapy: Moving Beyond the 5% Weight Loss Goal. J Endocr Soc 2023; 7:bvac195. [PMID: 36686585 PMCID: PMC9847544 DOI: 10.1210/jendso/bvac195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Despite professional society guidelines recommending that obesity be treated as a chronic disease by emphasizing the use of lifestyle modification in conjunction with pharmacotherapy, antiobesity medications are uncommonly prescribed in most clinical practices. The recent Food and Drug Administration approval of semaglutide 2.4 mg weekly to treat obesity-as well as other forthcoming advancements in diabetes and antiobesity medications-highlights the potential of pharmacotherapy to significantly augment weight loss efforts. In this Expert Endocrine Consult, we review the evolving role of antiobesity pharmacotherapy in clinical practice and suggest a framework for the use of these medications.
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Affiliation(s)
- Connor Enright
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Elizabeth Thomas
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA,Endocrinology Section, Rocky Mountain Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - David R Saxon
- Correspondence: David Saxon, MD, Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA.
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