Guillaume Lassailly: The Role of MASH, Fibrosis in Bariatric Surgery Survival

Data from a first-of-its kind trial presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this weekend showed resolving metabolic dysfunction-associated steatohepatitis (MASH) without worsening of patient fibrosis is indicative of improved 15-year survival rates among such patients receiving bariatric surgery.

The findings, presented by study author Guillaume Lassailly, of the Centre Hospitalier Universitaire de Lille in France, would implicate the outcome of MASH resolution without worsening fibrosis to be a surrogate endpoint for the invasive procedure.

In an interview with HCPLive during The Liver Meeting, Lassailly discussed the clinically-implicative takeaways from his team’s findings, next steps for research, and how the outcomes relate to the embrace of MASH and metabolic dysfunction-associated liver disease (MASLD) nomenclature in hepatology as of this year.

HCPLive: What are the key takeaways from your team’s analysis of long-term bariatric surgery survival with MASH resolution and maintained fibrosis?

Lassailly: There are several key points that we can take it out of this study. The first key point, I think, is how rare are these data, because we are looking into long-term survival, and when we look out to our curves, we see that we do not have any impact on the first 5 years of follow-up and it's only in between 10 - 15 years of follow up where we really see an impact of our treatment on mortality. So, it's quite difficult to have cohorts with so long follow-up to prove that our clinical endpoints that we use to validate pharmacological drugs, that is, resolution of MASH without worsening of fibrosis, is associated in linked with mortality.

And somehow, our cohort in bariatric surgery is quite an opportunity to prove this point. And for the moment our data are, I think, robust in the context of bariatric surgery, but we clearly need to have also this kind of data outside the context of bariatric surgery, and to show it with clinical drugs. But the problem is that I'm quite afraid that we will need to wait a bit, at least 5 - 10 years, with patients under treatment, to really see the impact of this.

HCPLive: Combined with the adoption of MASH / MASLD disease terminology, do you think these findings will significantly benefit the streamline to bariatric surgery in high-risk patients?

Lassailly: In a way, it's not only our cohort that says that—it's also new trials that we saw, like the BRAVES trial that shows the major impact of bariatric surgery in the context of MASLD and also MASH. The only point I think is very important to emphasize is that for the moment, the BRAVES trial has proved the efficacy of bariatric surgery in patients that are not very severe. They have fibrosis, but they have low fibrosis. We have very few patients with a F3 fibrosis, like we have in drug trials. And we really want to have data of bariatric surgery in very severe patients.

And I think in the context of therapeutic development of bariatric surgery, the next step is to go to these patients with F3 fibrosis, even F4 fibrosis, and highly selective patients so we can make sure it's robust and true treatment—which I'm quite convinced, but we need data to prove it. And then we will think how we can decide where bariatric surgery should be positioned in the global therapeutic strategy of NAFLD and NASH.