Browsing by Author "Jia J."

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    A Framework for Best Practices and Readiness in the Advent of Anti-Amyloid Therapy for Early Alzheimer’s Disease in Asia
    (2024-08-27) Lee J.H.; Jia J.; Ji Y.; Kandiah N.; Kim S.Y.; Mok V.; Pai M.C.; Senanarong V.; Suh C.H.; Chen C.; Lee J.H.; Mahidol University
    Advances in biomarker-based diagnostic modalities, recent approval of anti-amyloid monoclonal antibodies for early Alzheimer’s disease (AD; mild cognitive impairment or mild dementia due to AD) and late-stage clinical development of other disease-modifying therapies for AD necessitate a significant paradigm shift in the early detection, diagnosis and management of AD. Anti-amyloid monoclonal antibodies target the underlying pathophysiological mechanisms of AD and have demonstrated a significant reduction in the rate of clinical decline in cognitive and functional outcome measures in patients with early AD. With growing recognition of the benefit of early interventions in AD, an increasing number of people may seek diagnosis for their subjective cognitive problems in an already busy medical system. Various factors such as limited examination time, lack of expertise for cognitive assessment and limited access to specialized tests can impact diagnostic accuracy and timely detection of AD. To overcome these challenges, a new model of care will be required. In this paper, we provide practical guidance for institutional readiness for anti-amyloid therapies for early AD in Asia, in terms of best practices for identifying eligible patients and diagnosing them appropriately, safe administration of anti-amyloid monoclonal antibodies and monitoring of treatment, managing potential adverse events such as infusion reactions and amyloid-related imaging abnormalities, and cross-disciplinary collaboration. Education and training will be the cornerstone for the establishment of new pathways of care for the identification of patients with early AD and delivery of anti-amyloid therapies in a safe and efficient manner to eligible patients.
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    Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia
    (2025-02-01) Choudhury A.; Kulkarni A.V.; Arora V.; Soin A.S.; Dokmeci A.K.; Chowdhury A.; Koshy A.; Duseja A.; Kumar A.; Mishra A.K.; Patwa A.K.; Sood A.; Roy A.; Shukla A.; Chan A.; Krag A.; Mukund A.; Mandot A.; Goel A.; Butt A.S.; Sahney A.; Shrestha A.; Cárdenas A.; Di Giorgio A.; Arora A.; Anand A.C.; Dhawan A.; Jindal A.; Saraya A.; Srivastava A.; Kumar A.; Kaewdech A.; Pande A.; Rastogi A.; Valsan A.; Goel A.; Kumar A.; Singal A.K.; Tanaka A.; Coilly A.; Singh A.; Meena B.L.; Jagadisan B.; Sharma B.C.; Lal B.B.; Eapen C.E.; Yaghi C.; Kedarisetty C.K.; Kim C.W.; Panackel C.; Yu C.; Kalal C.R.; Bihari C.; Huang C.H.; Vasishtha C.; Jansen C.; Strassburg C.; Lin C.Y.; Karvellas C.J.; Lesmana C.R.A.; Philips C.A.; Shawcross D.; Kapoor D.; Agrawal D.; Payawal D.A.; Praharaj D.L.; Jothimani D.; Song D.S.; Kim D.J.; Kim D.S.; Zhongping D.; Karim F.; Durand F.; Shiha G.E.; D'Amico G.; Lau G.K.; Pati G.K.; Narro G.E.C.; Lee G.H.; Adali G.; Dhakal G.P.; Szabo G.; Lin H.C.; Li H.; Nair H.K.; Devarbhavi H.; Tevethia H.; Ghazinian H.; Ilango H.; Yu H.L.; Hasan I.; Fernandez J.; George J.; Behari J.; Fung J.; Bajaj J.; Benjamin J.; Lai J.C.; Jia J.; Hu J.H.; Choudhury A.; Mahidol University
    Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.
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    Assessing pricing and affordability of HBV treatment in Asia–Pacific region: a barrier to elimination
    (2025-01-01) Chen J.; Jia J.; Zhuang H.; Zhang W.; Yang J.M.; Tanwandee T.; Payawal D.; Hamid S.; Sarin S.K.; Omata M.; Wang G.; Lau G.; Apasl Viral Elimination Task Force; Chen J.; Mahidol University
    Background: The Asia–Pacific (AP) region carries a substantial burden of HBV. Affordable HBV treatment is crucial to attain WHO’s elimination goal. This study assesses the pricing and affordability of HBV treatment in AP. Methods: A survey conducted among APASL members from 2 Aug to 30 Oct, 2023, gathered data on antiviral HBV drugs, treatment costs covering stages of chronic hepatitis B (CHB), compensated cirrhosis (CC), hepatocellular carcinoma (HCC), liver transplant, and monitoring expenses. Drug costs for TDF and ETV were compared to international reference price (TDF: $30, ETV: $36 per person per year), generating a median price ratio (MPR) where MPR < 1 indicated an acceptable local price. Affordability was evaluated by comparing yearly CHB treatment cost to yearly minimum wage in each country/area, all converted to 2023 US$. Results: ETV costs ranged from $42 per person per year in Pakistan to $2640 in Malaysia, while TDF costs varied from $12 in mainland China to $2446 in Hong Kong. Almost all MPR exceeded 1. Affordability of HBV treatment varied, with CHB patients in Australia paying 1.4% of minimum yearly wage to get 1 year CHB treatment, in contrast to Myanmar’s 78.6%. Affordability disparities were also evident for patients with CC, HCC, and liver-transplant needs, though monitoring costs were generally affordable. Conclusions: Despite patent expiration and availability of low-cost generics for TDF and ETV, HBV medication costs in Asia–Pacific region remain high. CHB treatment is generally unaffordable for patients, posing a significant barrier to HBV elimination in this endemic region.
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    Functional cure with new antiviral therapy for hepatitis B virus: a systematic review and meta-analysis
    (2025-01-01) Chen J.; Ji D.; Jia J.; Zhuang H.; Zhang X.; Wang F.S.; Zhang W.; Dou X.; Tanwandee T.; Sarin S.K.; Maiwall R.; Kumar M.; Goh G.B.B.; Ghazinyan H.; Chutaputti A.; Chen P.J.; You H.; Yu M.L.; George J.; Omata M.; Wang G.Q.; Lau G.; APASL Viral Elimination Taskforce; Chen J.; Mahidol University
    Background: Achieving a “functional” cure for chronic hepatitis B (HBV) is primary goal for novel antiviral treatments. We sought to evaluate efficacy and safety of these novel treatments and identified emerging barriers to achieving a functional cure. Approach: We systematically reviewed clinical trials from 2018 to 2023, identifying 244 trials from clinicaltrials.gov records on HBV. The primary outcome was functional cure rate at the end of follow-up (EOF). Secondary outcomes included changes in HBsAg levels, HBsAg loss rates, HBV DNA rebound, and adverse events. Meta-analysis was performed. Results: Our meta-analysis of 19 studies involving 1789 non-cirrhotic HBV patients found a minimal functional cure rate (0.0%, 95%CI 0.0–0.4%) and low HBsAg loss rates (0.9% at the end of treatment [EOT] and 0.1% at EOF). HBsAg levels declined at EOT (−0.41 log10 IU/mL, 95%CI −0.45 to −0.37, p < 0.001) but this reduction was not sustained to EOF. Virological relapse occurred in 20.5% of cases off-treatment. Although novel treatments were well-tolerated, they had higher adverse event rates (OR = 1.77, 95%CI 1.26–2.48). Challenges to achieving a functional cure include complex trial designs and unknown confounding factors. Conclusion: Novel antiviral treatments showed limited effectiveness in achieving HBsAg loss and reduction, highlighting the need to address identified barriers in future research.
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    Modernizing diagnosis of Alzheimer's disease: A review of global trends and Asia-specific perspectives
    (2025-08-01) Iwatsubo T.; Sperling R.A.; Algeciras-Schimnich A.; Arai H.; Barron A.M.; Benzinger T.L.S.; Carrillo M.C.; Chen C.; Choi S.H.; Fontana I.C.; Graff-Radford J.; Grill J.D.; Heidebrink J.; Hu C.J.; Ihara R.; Ikeuchi T.; Iwata A.; Ip F.C.F.; Fitri F.I.; Jack C.R.; Jeong J.H.; Jia J.; Kandiah N.; Kim S.Y.; Kowa H.; La Joie R.; Niimi Y.; Noritake R.; Okonkwo O.C.; Palmqvist S.; Rafii M.S.; Raman R.; Shen Y.; Simuni T.; Snyder H.M.; Sriwannopas O.; Stoeckel L.E.; van der Flier W.M.; Wang H.; Wilcock D.M.; Zetterberg H.; Zhou J.; Mahinrad S.; Sexton C.E.; Iwatsubo T.; Mahidol University
    The landscape of Alzheimer's disease (AD) and related dementias (ADRD) diagnosis is evolving rapidly, driven by advances in disease understanding, biomarker tools, and disease-modifying therapies. Modern diagnostic approaches emphasize biological precision, early detection, and dynamic frameworks that adapt to treatment-induced changes in disease biology. These frameworks enable opportunities for personalized interventions—encompassing pharmacological and non-pharmacological strategies—and for enhanced clinical trial design. However, implementing these advancements globally is influenced by diverse cultural, infrastructural, and regulatory factors. The 2024 Alzheimer's Association International Conference Advancements: Modernizing Diagnosis, held in Japan, provided a unique platform to explore these global dynamics, particularly from an Asian perspective. This article highlights key discussions from the conference, exploring the role of biomarker-based diagnostic frameworks in shaping the future of AD/ADRD research, diagnosis, and treatment. We highlight regional challenges and successes and emphasize ethical considerations and practical strategies needed to ensure equitable access to diagnostic and therapeutic innovations. Highlights: Advances in biomarkers are reshaping Alzheimer's disease diagnosis and treatment. Modern diagnostic frameworks highlight biological precision, early detection, and dynamic frameworks. The 2024 Alzheimer's Association International Conference Advancements: Modernizing Diagnosis explored challenges and opportunities in global biomarker implementation. The conference explored geographic-specific impacts, focusing on Asia.
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    Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update
    (2024-04-01) Cooke G.S.; Flower B.; Cunningham E.; Marshall A.D.; Lazarus J.V.; Palayew A.; Jia J.; Aggarwal R.; Al-Mahtab M.; Tanaka Y.; Jeong S.H.; Poovorawan K.; Waked I.; Hiebert L.; Khue P.M.; Grebely J.; Alcantara-Payawal D.; Sanchez-Avila J.F.; Mbendi C.; Muljono D.H.; Lesi O.; Desalegn H.; Hamid S.; de Araujo A.; Cheinquer H.; Onyekwere C.A.; Malyuta R.; Ivanchuk I.; Thomas D.L.; Pimenov N.; Chulanov V.; Dirac M.A.; Han H.; Ward J.W.; Cooke G.S.; Mahidol University
    The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic.
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    The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease
    (2025-04-01) Eslam M.; Fan J.G.; Yu M.L.; Wong V.W.S.; Cua I.H.; Liu C.J.; Tanwandee T.; Gani R.; Seto W.K.; Alam S.; Young D.Y.; Hamid S.; Zheng M.H.; Kawaguchi T.; Chan W.K.; Payawal D.; Tan S.S.; Goh G.B.b.; Strasser S.I.; Viet H.D.; Kao J.H.; Kim W.; Kim S.U.; Keating S.E.; Yilmaz Y.; Kamani L.; Wang C.C.; Fouad Y.; Abbas Z.; Treeprasertsuk S.; Thanapirom K.; Al Mahtab M.; Lkhagvaa U.; Baatarkhuu O.; Choudhury A.K.; Stedman C.A.M.; Chowdhury A.; Dokmeci A.K.; Wang F.S.; Lin H.C.; Huang J.F.; Howell J.; Jia J.; Alboraie M.; Roberts S.K.; Yoneda M.; Ghazinian H.; Mirijanyan A.; Nan Y.; Lesmana C.R.A.; Adams L.A.; Shiha G.; Kumar M.; Örmeci N.; Wei L.; Lau G.; Omata M.; Sarin S.K.; George J.; Eslam M.; Mahidol University
    Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.