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Real-world management of non-alcoholic steatohepatitis differs from clinical practice guideline recommendations and across regions

Lookup NU author(s): Professor Quentin AnsteeORCiD, Dr Kate HallsworthORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 The Authors. Background & Aims: Despite availability of diagnostic and management reference guidelines outlining standard of care for patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), national and regional guidelines are lacking, resulting in variations in patient management between regions. We retrospectively analyzed patient characteristics and management data from the Adelphi Real World NASH Disease Specific Programme™ for patients with NASH in the EU5, Canada, and the Middle East to identify gaps between real-world practice and that advocated by reference guidelines, irrespective of clinician awareness or consultation of guidelines. Methods: We performed an analysis of physicians (hepatologists, gastroenterologists, diabetologists) and their patients diagnosed with NASH. Physicians completed patient record forms for the next 5 consulting patients, collecting information on patient care, including diagnosis and disease management. Results: A total of 429 physicians provided data for 2,267 patients with NASH (EU5, n = 1,844; Canada, n = 130; Middle East, n = 293). Patient age, physician-defined fibrosis stage, comorbidities and symptoms, and diagnostic testing practices highlighted statistically significant differences across regions. Substantial disconnects between reference guidelines and real-world practice were observed. Use of liver function tests, non-invasive tests (e.g. ultrasound and transient elastography), and tests to exclude other conditions was suboptimal. Although lifestyle advice was widely provided, patients were less commonly referred to diet, exercise, and lifestyle specialists. Two-thirds of patients were receiving off-label treatment for NASH or associated underlying conditions with the aim of improving NASH, most commonly statins, metformin, and vitamin E. Conclusion: Real-world NASH management approaches differ across regions and from proposed standard of care represented by reference multidisciplinary guidelines. Establishment and awareness of, and adherence to regional and national guidelines may improve identification and management of patients with NASH and potentially improve outcomes in this population. Lay summary: Although reference guidelines are available to guide the management of patients with NASH, these are not widely used and there is a lack of national guidelines. Our study shows how clinical practice in the EU, Canada, and Middle East differs from proposed standard of care, particularly relating to how patients are diagnosed and treated. Wider establishment of, awareness of, and reference to guidelines may improve how physicians identify and manage patients with NASH.

Publication metadata

Author(s): Anstee QM, Hallsworth K, Lynch N, Hauvespre A, Mansour E, Kozma S, Marino J-P, Bottomley J, Piercy J, Higgins V

Publication type: Article

Publication status: Published

Journal: JHEP Reports

Year: 2022

Volume: 4

Issue: 1

Print publication date: 01/01/2022

Online publication date: 22/11/2021

Acceptance date: 09/11/2021

Date deposited: 09/01/2022

ISSN (electronic): 2589-5559

Publisher: Elsevier B.V.


DOI: 10.1016/j.jhepr.2021.100411


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Funder referenceFunder name
777377European Commission
Gilead Sciences, Inc.