New pharmacologic agents to treat fatty liver in diabetics are expected to be approved in 2020 and will target those with nonalcoholic steatohepatitis (NASH) and significant fibrosis (NASH-F). The FAST (Fibroscan + AST) score was recently developed to predict the presence of (NASH-F) based on measuring controlled attenuation parameter (CAP) for steatosis, liver stiffness measurement (LSM) for fibrosis, and AST for inflammation. The aim of this study was to assess the utility of FAST score in patients with T2DM and prediabetes to identify those that require NASH pharmacotherapy.
Methods: Consecutive patients with T2DM or A1c ≥5.7% who presented for evaluation of fatty liver were included. All had Fibroscan to measure CAP and LSM + AST within 6 months. Based on published data, FAST ≥0.75 was used to rule in the presence of NASH-F and therefore as an indication for pharmacotherapy. FAST < 0.40 was used to rule out NASH-F. Nominal and continuous variables were analyzed with chi-squared and 2-sided T-tests, respectively.
Results: 90 patients were identified; average age 56 (13.55) years, BMI was 35.06 (6.29) kg/m2, and 58 (64.4%) were female. A total of 11 (12.3%) patients had a FAST ≥0.75 indicating that they qualify for pharmacotherapy once available. Patients with FAST ≥0.75 were older (57.3 years vs. 47; p=0.01), had higher ALT (139.63 u/L vs. 57.06; p <0.01), and triglycerides (234.87 mg/dL vs. 162.44; p =0.02). Patients with FAST ≥0.75 were not more likely to have higher A1c, hypertension, or metabolic syndrome. 34 patients (37.7%) had FAST <0.4 indicating the absence of significant disease and 45 patients (50%) had FAST between 0.4 and 0.75.
Conclusion: Using a high cutoff value of 0.75, the FAST score identified 12% of patients with T2DM/prediabetes that will qualify for NASH pharmacotherapy. While 38% of patients can be stratified as low risk by using a cutoff value of 0.40, 50% of patients had intermediate FAST score values indicating the need for further workup.
P. Aggarwal: None. N. Alkhouri: Research Support; Self; Allergan plc.