Author information
1Department of Hepatology, Beaujon Hospital, AP-HP, Université Paris-Cité, Clichy, France.
2Barts Liver Centre, Queen Mary University of London, London, UK.
3Department of Medical Sciences, University of Torino, Torino, Italy.
4Lyon 1 University and Lyon South Hospital, Lyon, France.
5Department of Systems Medicine, University of Rome tor Vergata, Rome, Italy.
6UCM Digestive Diseases and Ciberehd, Virgen Del Rocío University Hospital, Institute of Biomedicine of Seville (CSIC/HUVR/US), University of Seville, Seville, Spain.
7Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
8Novo Nordisk A/S, Bagsværd, Denmark.
9Novo Nordisk Health Care AG, Zurich, Switzerland.
10City University of New York Graduate School for Public Health and Health Policy (CUNY SPH), New York, New York, USA.
11Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain.
12Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Abstract
Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) and its more severe subtype, metabolic dysfunction-associated steatohepatitis (MASH), are highly prevalent and strongly associated with obesity and type 2 diabetes (T2D). This study sought to identify challenges to the diagnosis, treatment and management of people living with MASLD and MASH and understand the key barriers to adopting relevant clinical guidelines.
Methods: A real-world, cross-sectional study (BARRIERS-MASLD) consisting of a quantitative survey and qualitative interviews of physicians in France, Germany, Italy, Spain and the United Kingdom was conducted from March to September 2023. Descriptive statistics were used for data analysis.
Results: A total of 626 physicians completed the survey; n = 10 from each country participated in the qualitative interviews. Physicians considered the presence of MASH to be highly impactful on how they treated people living with obesity (66%) and T2D (69%). Over one-third (35%) of the respondents could not identify any MASH-specific clinical guidelines issued by medical societies or associations top-of-mind, but overall awareness rose when prompted about country-specific guidelines. Physicians said they would need evidence of success (48%) and clinical guidelines that address common MASLD comorbidities (38%) to increase their adoption.
Conclusions: This study found that lack of awareness around MASLD and MASH clinical guidelines and clearly established care pathways, particularly for addressing common comorbidities, was a key factor preventing physicians from optimising care for people living with MASH in Europe. This research highlights opportunities to improve education and training about clinical guidelines and care coordination.