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In general, I think the NASH field is a farce in its current form.

First, the screening tool *seems* to recognize the disease before its too far (ie, they pick up fibrosis; or abnormal liver function tests) - thus the disease has already gone to a point of no return - a fibrotic liver that is not going to recur to its previous form.

And here, we have GILD failing... again.

https://www.fiercebiotech.com/biotech/gilead-s-selonsertib-f...

Dont get me wrong, the economics of medicine are that GI will likely need to reinvent themselves in some way (IR interventions for GI bleeds; inevitable decreased payments for scopes; the inevitable decrease in screening scopes needed as pts migrate to cologuard or guardant over time, etc).... but NASH aint it right now.

I suspect were targeting too late in the disease process (when fibrosis has already occurred), and have to go further upstream... which means we'll likely test and treat alot of patients that never would have gotten fibrosis in the first place, let alone liver cancer. This is alot like statins - treating patients without a measurable benefit (the NNT for 5 years of statin use is 104 to prevent one MI !!!)

47 million cases of NASH by 2027. only 42,000 cases of liver CA in US. The NNT for NASH drugs is going to be sky high and really hard to prove a reasonable benefit in post-market studies.

There is alot at stake for pharma to find a treatment; but I am suspicious patients best interests are at the core of their fight. I suspect any of the initial NASH drugs (if they ever get to market) are going to do alot more harm than good.
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