{
  "society": "EASL",
  "version": "2026_update_draft",
  "publication_date": "2026-04-01",
  "public_consultation_close": "2026-05-30",
  "title": "EASL 2026 Update Draft: NIT thresholds and pegozafermin",
  "status": "draft_public_consultation",
  "recommendations": [
    {
      "recommendation_id": "EASL-2026-R03",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4 < 1.3 low risk; >= 1.3 indeterminate; > 2.67 high risk; in adults >= 65, lower threshold raised to 2.0.",
      "text_kr_summary": "FIB-4 65세 이상 2.0 도입.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["17326139", "31430416"],
      "related_nits": ["FIB-4"],
      "related_drugs": [],
      "supersedes": ["EASL-2024-R03"]
    },
    {
      "recommendation_id": "EASL-2026-R04",
      "topic": "lsm_cutoff",
      "text_en": "VCTE LSM: < 8 kPa exclude; 8-15 kPa indeterminate; >= 15 kPa rule-in advanced fibrosis (raised from 12).",
      "text_kr_summary": "LSM rule-in 12->15 kPa.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["32492532", "39501011"],
      "related_nits": ["LSM"],
      "related_drugs": [],
      "supersedes": ["EASL-2024-R04"]
    },
    {
      "recommendation_id": "EASL-2026-R07",
      "topic": "resmetirom",
      "text_en": "Resmetirom recommended for non-cirrhotic F2-F3 MASH following EMA approval (2025).",
      "text_kr_summary": "EMA 승인 후 F2-F3 MASH 레스메티롬 권고.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["38324483"],
      "related_nits": [],
      "related_drugs": ["resmetirom"],
      "supersedes": ["EASL-2024-R07"]
    },
    {
      "recommendation_id": "EASL-2026-R13",
      "topic": "pegozafermin",
      "text_en": "Pegozafermin may be considered in F2-F3 MASH (ENLIVEN-2 phase 3 readout positive); pending EMA review.",
      "text_kr_summary": "페고자페르민 F2-F3 MASH 고려; EMA 심사.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["37195353"],
      "related_nits": [],
      "related_drugs": ["pegozafermin"]
    },
    {
      "recommendation_id": "EASL-2026-R14",
      "topic": "elf_test",
      "text_en": "ELF < 9.8 rule out, >= 11.3 rule in; useful as second-tier in primary care referral pathway.",
      "text_kr_summary": "ELF 9.8/11.3 cutoff; 1차 의료 의뢰 경로.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["27649089"],
      "related_nits": ["ELF"],
      "related_drugs": []
    }
  ]
}