Quentin M Anstee1,2, Eric J Lawitz3, Naim Alkhouri3, Vincent Wai-Sun Wong4, Manuel Romero-Gomez5, Takeshi Okanoue6, Michael Trauner7, Kathryn Kersey8, Georgia Li8, Ling Han8, Catherine Jia8, Lulu Wang8, Guang Chen8, G Mani Subramanian8, Robert P Myers8, C Stephen Djedjos8, Anita Kohli9, Natalie Bzowej10, Ziad Younes11, Shiv Sarin12, Mitchell L Shiffman13, Stephen A Harrison14, Nezam H Afdhal15, Zachary Goodman16, Zobair M Younossi16. 1. Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom. 2. The Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom. 3. Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX. 4. Department of Medicine and Therapeutics, The Chinese Hospital of Hong Kong, Hong Kong. 5. Hospital Universitario Virgen del Rocio, Seville, Spain. 6. Saiseikai Suita Hospital, Suita City, Osaka, Japan. 7. Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. 8. Gilead Sciences, Inc., Foster City, CA. 9. The Institute for Liver Health, Chandler, AZ. 10. Ochsner Medical Center, New Orleans, LA. 11. Gastro One, Germantown, TN. 12. Institute of Liver and Biliary Sciences, New Delhi, Delhi, India. 13. Bon Secours Liver Institute of Virginia, Richmond, VA. 14. Pinnacle Clinical Research, San Antonio, TX. 15. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. 16. Inova Fairfax Hospital, Falls Church, VA.
Abstract
Accurate noninvasive tests (NITs) are needed to replace liver biopsy for identifying advanced fibrosis caused by nonalcoholic steatohepatitis (NASH). We analyzed screening data from two phase 3 trials of selonsertib to assess the ability of NITs to discriminate advanced fibrosis. Centrally read biopsies from the STELLAR studies, which enrolled patients with bridging fibrosis and compensated cirrhosis, were staged according to the NASH Clinical Research Network classification. We explored associations between fibrosis stage and NITs, including the nonalcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 (FIB-4) index, Enhanced Liver Fibrosis (ELF) test, and liver stiffness by vibration-controlled transient elastography (LS by VCTE). The performance of these tests to discriminate advanced fibrosis, either alone or in combinations, was evaluated using areas under the receiver operating characteristic curve (AUROCs) with 5-fold cross-validation repeated 100 times. Of the 4,404 patients screened for these trials, 3,202 had evaluable biopsy data: 940 with F0-F2 fibrosis and 2,262 with F3-F4 fibrosis. Significant differences between median values of NITs for patients with F0-F2 versus F3-F4 fibrosis were observed: -0.972 versus 0.318 for NFS, 1.18 versus 2.20 for FIB-4, 9.22 versus 10.39 for ELF, and 8.8 versus 16.5 kPa for LS by VCTE (all P < 0.001). AUROCs ranged from 0.75 to 0.80 to discriminate advanced fibrosis. FIB-4 followed by an LS by VCTE or ELF test in those with indeterminate values (FIB-4 between 1.3 and 2.67) maintained an acceptable performance while reducing the rate of indeterminate results. Conclusion: Among patients being considered for enrollment into clinical trials, NITs alone or in combination can reduce the need for liver biopsy to discriminate advanced fibrosis caused by NASH. The predictive value of these tests for general screening will require confirmation in a real-world population.
Accurate noninvasive tests (NITs) are needed to replace liver biopsy for identifying advanced fibrosis caused by nonalcoholic steatohepatitis (NASH). We analyzed screening data from two phase 3 trials of selonsertib to assess the ability of NITs to discriminate advanced fibrosis. Centrally read biopsies from the STELLAR studies, which enrolled patients with bridging fibrosis and compensated cirrhosis, were staged according to the NASH Clinical Research Network classification. We explored associations between fibrosis stage and NITs, including the nonalcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 (FIB-4) index, Enhanced Liver Fibrosis (ELF) test, and liver stiffness by vibration-controlled transient elastography (LS by VCTE). The performance of these tests to discriminate advanced fibrosis, either alone or in combinations, was evaluated using areas under the receiver operating characteristic curve (AUROCs) with 5-fold cross-validation repeated 100 times. Of the 4,404 patients screened for these trials, 3,202 had evaluable biopsy data: 940 with F0-F2 fibrosis and 2,262 with F3-F4 fibrosis. Significant differences between median values of NITs for patients with F0-F2 versus F3-F4 fibrosis were observed: -0.972 versus 0.318 for NFS, 1.18 versus 2.20 for FIB-4, 9.22 versus 10.39 for ELF, and 8.8 versus 16.5 kPa for LS by VCTE (all P < 0.001). AUROCs ranged from 0.75 to 0.80 to discriminate advanced fibrosis. FIB-4 followed by an LS by VCTE or ELF test in those with indeterminate values (FIB-4 between 1.3 and 2.67) maintained an acceptable performance while reducing the rate of indeterminate results. Conclusion: Among patients being considered for enrollment into clinical trials, NITs alone or in combination can reduce the need for liver biopsy to discriminate advanced fibrosis caused by NASH. The predictive value of these tests for general screening will require confirmation in a real-world population.
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