Unmet needs around CLD treatment

Linkage from primary to secondary care is weak and non-standardised

Referral and follow-up pathways from primary to secondary care are lacking or non-standardised, with limited access to multidisciplinary care and imbalances in the treatment-decision making process1–4 

Liver investigations are routinely performed by primary practitioners; however, knowledge and confidence gaps arise in detecting and managing CLD in primary care1


Nationally embedded management pathways, especially for patients who present in primary care with etiologies beyond hepatitis, such as NAFLD,1 are lacking and loss to follow-up remains an ongoing challenge2


Referral patterns can vary considerably and greatly influence the selection of the treatment, especially in those with advanced disease3,4


Treatment success is hindered by health disparities, inequalities to treatment access and curative options

Health disparities and inequalities affect access to adequate care for people with CLD developing from different etiologies5

Despite the high prevalence of NAFLD among Hispanic people, these are only represented in 12% of clinical studies6

In the USA, women are less likely to receive liver transplantation for NASH or cirrhosis than men7,8


Access to DAA therapy for HCV is challenging for racial and ethnic minorities and socioeconomically disadvantaged groups5

With regards to HBV infections, rates of linkage to care, HBV testing, referral to specialists, treatment appear to be substantially low in Asian groups5



CLD is often associated with comorbidities which contribute to patients' treatment burden

The management of CLD and its comorbidities requires polypharmacy, often causing medication burden and poor treatment adherence and misuse, ultimately leading to negative health outcomes9


≥5 medications consumed daily


≥10 medications consumed daily

…are prevalent in patients with various CLDs, with new medications added over time as the

disease progresses9


Polypharmacy is needed to treat or cure modifiable diseases, prevent and manage complications, reduce hospitalisation, control symptoms, improve QoL and lower the risk of preventable death in CLD, particularly among patients with NAFLD. However, accumulation of medications and frequent changes to therapy can lead to medication burden and a complex regimen prone to mismanagement9

In multiple studies, inappropriate use of medications has been associated with negative outcomes, including hospitalisation and death in people with CLD10-13


1.      Pryke R. and Guha N. J hepatol 2023;78:663-71.

2.      Maher S, et al. J Gastroenterol Hepatol 2021;36:2255-60.

3.      Hyder O, et al. J Am Coll Surg 2013;217:896-906.

4.      Soares KC, et al. Ann Surg Oncol 2014;21:1059-61.

5.      Kardashian A, et al. Hepatology 2023;77:1382-403.

6.      Patel P, et al. World J Hepatol 2020;12:506-18.

7.      Loy VM, et al. Clin Transplant 2018;32:e13297.

8.      Kim WR, et al. Gastroenterology 2021;161:1887-95.e4.

9.      Hayward KL. and Weersink RA. Hepatol Commun 2020;4:1562-1577

10.   Hayward KL, et al. Hepatol Commun 2019;3:620-631.

11.   Johnson KB, et al. Dig Dis Sci 2014;59:174-182.

12.   Volk ML, et al. Am J Gastroenterol 2012;107:247-252.

13.   Agrawal K, et al. South Med J 2015;108:682-687. 

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