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Do you qualify for Wegovy or Rezdiffra for MASH with liver fibrosis stage F2 or F3?

Cogent Family Healthcare Blog Do you qualify for Wegovy or Rezdiffra for MASH with liver fibrosis stage F2 or F3?

The FDA has just approved Wegovy for liver fibrosis stages F2 or F3 becoming the second approved medication after Rezdiffra which we have already been using to treat patients with liver fibrosis identified on the guideline-required Fibroscan liver ultrasound provided in our office. We are one of the first primary care offices in the Bay Area to provide the Fibroscan ultrasound.

Liver fibrosis is a dangerous disease and very common. Liver fibrosis is the first major independent risk factor for heart attack in decades and can lead to liver failure called cirrhosis which can require a liver transplant and can also cause liver cancer. Besides alcohol, simply the accumulation of fat in the liver called fatty liver (“liver steatosis”) can cause the inflammation of the liver cells called fibrosis that can cause cirrhosis.

34% of US adults have fatty liver and 7% have liver fibrosis stages F2 or F3. 70% of those with diabetes have fatty liver. Already liver cirrhosis due to liver fat is the leading cause of liver transplantation in the United States, now ahead of alcohol-caused cirrhosis, in women and soon to be for men. It is projected that in year 2050 so many people will need liver transplants due to fat in the liver causing cirrhosis (liver failure), that there will not be enough healthy donor livers or hospitals to do the procedures. 

Risk factors for liver fibrosis are obesity (BMI 30+), diabetes, prediabetes, insulin resistance, abnormal cholesterol or triglycerides, high ALT or AST lab result, lack of exercise and age over 40 and is associated with hypertension (high blood pressure).

Liver fibrosis is nearly always asymptomatic – you don’t feel anything abnormal. No matter what your weight, risk factors, medical conditions or lab results you must check your FIB-4 score yourself (see below) and if above 1.0, have a Fibroscan ultrasound or other testing (MRI) to find out whether you have liver fibrosis. The Fibroscan ultrasound is the most convenient (20-30 minutes in our office), and least expensive, and is FDA approved and recommended by all guidelines for liver fibrosis testing.

The Fibroscan costs under $300 usually covered by insurance in the presence of risk factors; A required subsequent remote results discussion visit (billed as a standard 99213 or 99214 office visit depending on discussion complexity) is subject to deductible.

We send your report and the results visit note to your primary care physician and schedule any recheck Fibroscans required based on your having liver steatosis (fat) or liver fibrosis, at our office in the future. 

If you have any of the above risk factors, you need to find out whether you may have MASH by checking whether your FIB-4 score is over 1.0 (see below why I and many other doctors use the FIB-4 cutoff of 1.0*). Enter from your most recent standard lab results (ALT, AST and platelets) here: https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis

If your FIB-4 score is over 1.0 you can request a Fibroscan by submitting your information and “Interested in Fibroscan” with your primary care physician’s name and phone and fax numbers, into the Contact Us page message field on this website.

We provide Fibroscan (and IMT) testing and results discussion visit without further primary care services to patients of any age but only provide further primary care services to patients age 18 through 69 at the time of joining the practice. We accept only PPO commercial, traditional Medicare or PPO Medicare Advantage, but do not accept Medi-Cal (out of pocket not legally allowed for Medi-Cal but OK for all other insurance) or HMO of any kind. Asking insurance whether BASS Medical Group tax ID 562-605-608 is in-network is required to determine insurance network participation.

* Rather than using the old definition of MASH of elevated ALT, the more appropriate measure is elevated FIB-4, for the following reason: FIB-4 correlates better than elevated ALT with future negative liver-related outcomes such as bleeding varices and hepatic encephalopathy. Multiple guidelines recommend following an elevated FIB-4 value with a Fibroscan test to confirm and quantify the presence of hepatic fibrosis.

A FIB-4 value of 1.0 or greater is a more medically correct definition of MASH than a value of 1.3 or greater, for the following reasons:

2.   https://doi.org/10.1053/j.gastro.2023.06.013 Gastroenterology 2023;165:1080–1088. AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. Julia J. Wattacheril,1,2,* Manal F. Abdelmalek,3,* Joseph K. Lim,4 and Arun J. Sanyal5

Page 1082, first full paragraph, states that the performance of a FIB-4 cutoff of 1.24 showed a specificity for the absence of advanced fibrosis of 71.2%, indicating 28.8% of patients with advanced fibrosis would be classified as normal due to a FIB-4 value less than 1.24. The percent of early hepatic fibrosis patients mis-classified as normal with a FIB-4 cutoff of 1.24 would of course be higher. This is unacceptable for a screening test for such a dangerous and treatable condition as hepatic fibrosis, which should detect a wider group of patients who may have hepatic fibrosis, given that the more definitive non-invasive imaging Fibroscan test is safe, inexpensive and easily accessible to confirm and quantify the presence of hepatic fibrosis.