S3-E43.5 – The Future of Combination Agents in NASH Therapy

S3-E43.5 - The Future of Combination Agents in NASH Therapy
First author Naim Alkhouri and last author Mazen Noureddin join the Surfers to discuss their recently published article, Safety and efficacy of combination therapy with semaglutide, cilofexor and firsocostat in patients with non-alcoholic steatohepatitis: A randomised, open-label phase II trial (JHEP, 2022). This episode explores the future of combination agents in NASH Therapy.

The group investigates potential for different combination packages, beginning with Roger’s suggestion for an oral semaglutide. Naim notes that there are other combination trials in the works that may provide more insight.

The episode then wraps up with Roger’s final question: in seven years, what percentage of patients being treated for NASH fibrosis, non-cirrhotic then cirrhotic, will be treated using combination therapies? Naim thinks the majority of patients with NASH cirrhosis will be on combination therapy, and the majority of patients with F2 or F1 fibrosis will be on monotherapy. He also thinks F3 will see a trend of adding more agents over time to prevent progression to cirrhosis. Mazen suggests in seven years we will not get to combo for NASH patients because of regulation, partnership, and logistics. Louise settles for a position between Naim and Mazen. Jörn highlights that many hurdles remain, especially in identifying these patients. Roger agrees that these diagnostics will be hard to scale over the next seven years. He also imagines there to be less combination packages and more step therapy.

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