Echosens: The Global Enabler of NASH Drug Development with Proprietary Non-Invasive Diagnostic Technology

French tech company Echosens occupies a unique position in the NASH field. It is not a developer of new NASH therapeutics, but rather a manufacturer of diagnostic equipment for liver diseases. By providing scarce diagnostic technologies that assist pharmaceutical companies in their development of new NASH drugs, Echosens has, to some extent, assumed the role of a “shovel seller” in this gold rush.

Founded in 2001, Echosens has accumulated 22 years of expertise in liver disease diagnosis. Through years of iterative upgrades, its core product, FibroScan, has been widely adopted in over 100 countries and regions worldwide, becoming a highly recognized tool for clinical research and auxiliary diagnosis within the hepatology community both in China and internationally.

In fact, the challenges to be addressed in the NASH field extend beyond new drug development,Echosens is focused on addressing another pressing dilemma in this field—breaking through the bottleneck of precise, non-invasive diagnosis.

To confirm a diagnosis of NASH, it is typically necessary to evaluate steatosis, inflammation, and fibrosis using scoring systems. Invasive liver biopsy, which allows for direct observation of hepatic tissue morphology, is the most intuitive method and has become the gold standard for diagnosing NASH. However, this procedure is expensive, carries a risk of complications, and has limited accessibility. Furthermore, liver biopsy interpretation is subjective, with final diagnostic results heavily dependent on the physician’s experience. Therefore, there is an urgent need for more precise and efficient diagnostic methods to replace current practices.

These limitations have sparked a transformative shift in the diagnostic approaches for NASH and other liver diseases, with non-invasive or minimally invasive testing becoming the prevailing trend. In particular, imaging-based diagnostic methods have emerged as a preferred choice in the field of NASH.

In the field of NASH, where accurate and reliable non-invasive diagnostic methods are currently lacking, Echosens is a pioneer.

Echosens was founded based on the doctoral thesis of its founder and Chief Technology Officer, Laurent Sandrin, on transient elastography.

From 1998 to 2000, Laurent Sandrin earned his Ph.D. under the supervision of Professor Mathias Fink at the Institut Laue-Langevin in Paris, France, where he developed the first ultrasound imaging device and transient elastography technology.

Leveraging this core technology, Laurent Sandrin co-founded Echosens with friends in 2001 and invented FibroScan, a device for liver disease diagnosis. Based on vibration-controlled transient elastography, FibroScan became the first device to utilize shear waves for quantitative elastography.

Laurent Sandrin, Founder and Chief Technology Officer of Echosens. Source: Echosens official website

FibroScan is a novel non-invasive device for detecting liver fibrosis.By measuring liver stiffness to assess the degree of liver fibrosis and accurately stage it, this method can not only partially replace liver biopsy but also facilitate the comprehensive diagnosis of chronic hepatitis. Meanwhile, FibroScan is also a novel quantitative diagnostic system for fatty liver disease; by calculating the Controlled Attenuation Parameter (CAP), it enables quantitative assessment of the severity of hepatic steatosis, thereby facilitating regular clinical follow-up of fatty liver progression in patients.

To promote and support the use of FibroScan in the field of liver disease, Echosens has published more than 3,500 publications, obtained over 100 international patents, and invests 12% of its annual sales revenue in product development and iteration.

Through these efforts,FibroScanIt has been included in liver disease testing guidelines by multiple authoritative institutions or organizations, or recommended as an official device for liver stiffness measurement, and has obtained certifications from regulatory authorities such as the European Union CE, the U.S. FDA, and China’s NMPA.Currently, this diagnostic system is recommended by the European Association for the Study of the Liver (EASL) Clinical Practice Guidelines, the Asia-Pacific Association for the Study of the Liver (APASL) Consensus on the Management of Chronic Hepatitis B, the Chinese Guidelines for the Prevention and Treatment of Chronic Hepatitis B, and the American Association for the Study of Liver Diseases (AASLD) Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma. Furthermore, with established diagnostic criteria in both China and Europe, its test results offer greater authority and comparability.

Nowadays,FibroScan has been deployed in nearly 4,000 hospitals across more than 100 countries and regions, with over 70 global distributors, enabling millions of liver examinations. This device has become the preferred choice for NASH diagnosis., its highly complex and proprietary R&D technology has remained difficult to successfully replicate to this day.

Meanwhile, FibroScan has undergone several updates and iterations over the past 20 years. The current lineup includes a mini portable model, facilitating physicians’ daily clinical practice, as well as newer devices for advanced liver disease assessment. These instruments evaluate liver fibrosis, hepatic steatosis, and portal hypertension, enabling not only the identification of advanced fibrosis in patients with non-alcoholic steatohepatitis (NASH) but also the stratification of cirrhosis severity.

Selected Echosens FibroScan Products, Source: Echosens Official Website

"Supported by strong performance, Echosens had planned to list in Hong Kong, but the plan ultimately fell through."But this led to its connection with China through the acquisition by Furuishare.Furui Pharmaceutical is a Beijing-based liver disease-focused medical enterprise founded in 1998, specializing in business expansion through investment and acquisitions.

In 2007, Furuishare introduced Echosens’ FibroScan and became its exclusive distributor in China, a strategic business decision that laid the foundation for the subsequent acquisition.

In June 2011, Furui Shares acquired Echosens for €20 million as its original shareholders exited, making Echosens a wholly-owned subsidiary of Furui Shares.

Rather than providing Echosens with further opportunities to expand in the Chinese market, this acquisition laid the foundation for Furui Shares’ corporate leap. According to Furui Shares’ annual financial reports over the years, following the acquisition of Echosens, Furui Shares’ total revenue grew from RMB 210 million in 2011 to RMB 604 million in 2015.

Following this, Furui Shares facilitated a strategic investment in Echosens, with investors including the Cathay China-France Fund and OrbiMed, a U.S. healthcare-focused investment fund. As a result, Furui Shares’ ownership stake changed from full control to 51%.

With the support of a diversified shareholder base, Echosens has accelerated its business expansion and the establishment of distribution networks in China, North America, and other international markets.Cathay Capital assisted Echosens in establishing a manufacturing facility in China and redefined its China market strategy through localized production, development of targeted products, and optimization of distribution networks. These efforts further enhanced the company’s performance in the Chinese market. Additionally, Cathay Capital helped Echosens enter the U.S. market and advance its internationalization process, resulting in significant growth in sales revenue.

Meanwhile, Cathay Capital assisted Echosens in executing its global strategy to acquire advanced medical technologies, thereby solidifying Echosens’ technological advantages and market-leading position.

Echosens has not disappointed its shareholders, with its FibroScan product remaining a key revenue driver for Furu Pharmaceutical. In 2021, based on the revenue composition of Furu Shares, the medical device business, represented by FibroScan, generated RMB 546 million in revenue, accounting for 60.8% of the company’s total income.

According to Foreseer Pharma, the global installed base of FibroScan devices has exceeded 5,000 units, with a market penetration rate of 5%. In China, the installed base is nearly 500 units, with a market penetration rate of 3.5%. The annual number of patient tests exceeds 3 million, and the number of participants in clinical studies has surpassed 400,000.

This undoubtedly demonstrates that Echosens plays a pivotal role within Furuishare and serves as a significant force in the field of liver disease diagnosis.

Currently, the profits generated by FibroScan primarily stem from two areas: advances in drug development and subsequent commercialization. With the support of Furu Pharmaceutical, Echosens’ commercialization pathway has been further broadened.

Initially, Echosens’ customers were primarily hospitals, with FibroScan mainly recommended as a tool for liver disease screening to improve patient access to liver disease diagnosis. Furi Pharmaceutical has further deepened the collaboration between Echosens and pharmaceutical companies.As no drugs have yet been approved for the treatment of non-alcoholic steatohepatitis (NASH), and FibroScan, as a globally recognized clinical assessment standard, is capable of supporting all critical stages from drug development to clinical trials, there is substantial demand for FibroScan among pharmaceutical companies.

Under this demand,Furui Co., Ltd. has facilitated in-depth collaborations between Echosens and pharmaceutical companies such as Pfizer, Gilead Sciences, and Novo Nordisk. Among them, Pfizer has become one of the company’s top five customers.

In June 2022, Novo Nordisk announced a collaboration with Echosens to advance the early diagnosis of non-alcoholic steatohepatitis (NASH). Given that its FibroScan technology is recognized as the best-validated tool for identifying advanced disease and predicting liver-related outcomes, this partnership will support Novo Nordisk’s development of novel NASH therapeutics.

Novo Nordisk and Echosens have structured their collaboration into three phases. In the initial phase, Novo Nordisk will employ combined screening using FIB-4 and FibroScan to identify and enroll suitable patients with non-alcoholic steatohepatitis (NASH) for its global clinical development programs. During the intermediate phase, as Novo Nordisk advances its NASH drug development, FibroScan will serve as a tool for monitoring therapeutic response and conducting routine follow-up assessments. Concurrently, Novo Nordisk and Echosens will collaborate to upgrade and enhance FibroScan’s functionalities, enabling more scientific and precise stratification of NASH patients. In the final phase, following the market launch of NASH therapies, Novo Nordisk and Echosens will jointly promote FibroScan as a key diagnostic and monitoring tool for NASH treatment.

It is evident that Echosens’ FibroScan has not only expanded its reach across a broad spectrum of use cases, such as hospital-based screening and diagnosis and the development of novel NASH therapeutics by pharmaceutical companies, but also vertically integrated its services to cover every stage from early-stage drug development to post-marketing patient health monitoring and management. As a result, the market prospects for FibroScan have become increasingly promising.

In addition to collaborating with multinational corporations (MNCs), Echosens’ client base now includes biotech companies focused on novel drug development for non-alcoholic steatohepatitis (NASH), such as Intercept, Madrigal, and Akero, positioning its market share for further growth.Echosens’ breakthroughs in the field of liver disease diagnosis have provided strong support for the development of new drugs for NASH. The iterative upgrades of FibroScan will continue, and FibroScan will invariably play a significant role in the eventual market launch of future NASH therapeutics.