Real-world work productivity is impaired in people with metabolic dysfunction-associated steatotic liver disease in the USA

Background & Aims: The impact of metabolic dysfunction-associated steatohepatitis (MASH) on patient-reported outcomes is poorly understood. We assessed work productivity burden in a real-world population with suspected/confirmed MASH, comparing work productivity and symptoms across subgroups (risk status, age, BMI, and comorbidities) in the USA using secondary data from Adelphi Real World MASH Disease Specific Programmes™, cross-sectional surveys of physicians and consulting patients in 2019 and 2022. Methods: Physicians (hepatologists, gastroenterologists, and endocrinologists) reported sociodemographic data and signs/symptoms for eight or fewer consecutive participants with MASH. Participants voluntarily completing questionnaires that assessed work productivity, health status, and quality of life/symptoms were categorized with low-, indeterminate-, or high-risk MASH using physician-stated fibrosis stage and derived risk categories. Principal components factor analysis identified factors from MASH signs and symptoms. Elastic net regression determined features associated with work productivity impairment. Results: <0.001 across all risk categories). Overall work impairment scores were 18.8% in low-risk and 19.9% in high-risk MASH. Of the 14 physician-reported signs/symptoms, 11 were significantly associated with physician-stated fibrosis stage and/or derived risk category. Two clusters of signs and symptoms ('memory loss/swelling legs/abdomen' and 'fatigue/sleep disturbance/insomnia/general weakness') and female sex were the strongest work impact predictors. Conclusions: Activity impairment was greater in participants with high-risk MASH, whereas overall work impairment was comparable, almost 20%, in low- and high-risk MASH. Non-specific symptoms of fatigue, sleep disturbance, and general weakness associated with MASH and other conditions predicted work impact in low-risk MASH. Thus, early detection and management of MASH could ameliorate work impairment. Impact and implications: Even in its early stages, when otherwise asymptomatic, metabolic dysfunction-associated steatohepatitis (MASH) may impact the ability to work. Using the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaire, we identified activity and overall work impairment in people with high- and low-risk MASH. We found a link between difficulty working and other signs, such as tiredness, sleep disturbance, and general weakness, in low-risk MASH that are not specific to MASH but can be associated with liver health. These general, non-specific signs could represent possible early warning signs preceding reduced productivity in patients with MASH.