Photo Credit: iStock.com/Mohammed Haneefa Nizamudeen

Physician’s Weekly talked with Andrew M. Moon, MD, and Jaideep Behari, MD, PhD, about the impact of MASH on quality of life, fatigue, and emotional strain.

Research published in Current Medical Research and Opinion gives clinicians a better understanding of the complex effects of metabolic dysfunction-associated steatohepatitis (MASH) on their patients living with the disease.

The study team conducted a concept elicitation phone or online video interview with participants. In the one-on-one interviews, researchers asked patients open-ended questions about their MASH-related experiences and perspectives as well as their symptoms, symptom severity and bother, and the impact of MASH on their everyday activities.

The researchers found that:

• The most bothersome impacts participants reported were relationships or social interactions (90.9% of respondents), psychological or emotional impact (78.6% of respondents), the economic burden (45.5% of respondents), and physical impact (42.9% of respondents).
• For 35.0% of participants, symptom-free days were considered good days. By contrast, fatigue, lack of energy, bloating, pain, lack of focus, or low self-esteem were symptoms experienced on bad days.
• The most frequent MASH symptoms included fatigue (75.0%), being overweight (73.7%), weakness, lethargy, or decreased energy (70.0%), abdominal discomfort (68.4%), feeling bloated or swollen (65%), and general discomfort (55.6%).

Physician’s Weekly (PW) talked with Andrew M. Moon, MD, MPH, and Jaideep Behari, MD, PhD, two transplant hepatologists who were not involved in the study, about its potential impact on the care of patients with MASH.

PW: Why was this study necessary?

Andrew M. Moon, MD, MPH: MASH is a large and growing health issue and a leading cause of cirrhosis and liver cancer in the United States. This study is important because it emphasizes the need for both clinical care and research to focus on how MASH leads to symptoms and impaired quality of life. As we begin to get new treatments for MASH, it is important to assess not only their effects on liver inflammation and scarring but also their effects on symptoms and quality of life.

Jaideep Behari, MD: Understanding the impact of any disease on a person’s life is the foundational principle of patient-centered care. While patient-reported outcome measures are starting to be incorporated into clinical trials focused on MASH, we still have a limited understanding of how profoundly the disorder affects the daily lives of our patients. This study, although in a small number of patients, provides important information on this issue.

What are the most important findings?

Dr. Behari: MASH is not just a liver disease but is truly a multisystem disorder. This study provides important insights into the impact of MASH-associated symptoms on patients’ lives and the critical importance of providing them with patient-centered care.

This study adds to a growing body of research supporting the use of patient perspectives, quality-of-life issues, and improvement in symptoms when making treatment decisions and evaluating the effectiveness of new non-pharmacological treatments as well as drug therapies.

Dr. Moon: This study confirms much of what I hear from patients with MASH I see in [the] clinic. It provides more information supporting the all-encompassing impact that a MASH diagnosis can have on patients.

Are any strengths or limitations of the study worth noting?

Dr. Behari: The study enrolled a relatively small number of patients. Also, patients with MASH often have comorbid conditions, such as obesity and diabetes, and some symptoms may have been due to other disorders. For example, many symptoms related to sleep and fatigue may have been due to underlying obstructive sleep apnea.

What questions remain unanswered for you?

Dr. Moon: It remains to be seen whether weight-loss interventions and some of the newer MASH therapies will have an impact on these symptoms and improve quality of life. My research focuses on how remote monitoring and earlier notification and intervention for these symptoms may help improve outcomes for patients with liver disease and liver cancer.

Dr. Behari: This study highlights the significant impact of MASH on patients’ lives. However, much work remains to be done to understand how and why these symptoms occur and the best strategies to mitigate them. An exciting area of research is the impact of newly approved treatments and drugs currently in clinical trials on ameliorating these symptoms. Another interesting question is how lifestyle modification with better nutrition, increased physical activity, and cessation of alcohol and tobacco use may improve some symptoms even without drug therapy.