Click Record or type field notes...

Patel outlined her evolving approach to treatment sequencing in NASH. For patients with fibrosis stage F2 or higher and concurrent metabolic syndrome, she now initiates pharmacotherapy within 60 days of diagnosis rather than waiting for lifestyle modification failure. She described a structured shared decision-making conversation using a visual risk calculator that incorporates age, fibrosis stage, metabolic comorbidities, and projected 10-year cirrhosis risk. She reported that this approach increased patient treatment acceptance from 52% to 78% in their clinic. She emphasized that the biggest bottleneck is not physician willingness but patient understanding of a disease they cannot feel — asymptomatic F2 patients routinely underestimate progression risk.

Dr. Patel identified a critical gap in longitudinal fibrosis tracking for NASH patients on active therapy. Mount Sinai currently monitors 420 patients using serial FibroScan every 6 months, but she noted there is no validated consensus on what constitutes a clinically meaningful improvement in liver stiffness measurement — the field uses arbitrary percentage thresholds that were never prospectively validated. She proposed developing a standardized fibrosis response criteria framework analogous to RECIST in oncology, incorporating paired biomarker trajectories with imaging endpoints. She has preliminary data from 180 patients showing that a composite score combining delta-ELF with delta-LSM at 12 months predicts cirrhosis-free survival at 5 years with 82% accuracy. She expressed strong interest in co-developing a multi-center validation protocol with our medical affairs team and could mobilize her network of 8 academic hepatology centers for enrollment.