Learning Objectives
• Incorporate into practice NITs that optimize diagnosis, staging, and monitoring of MASH
• Implement timely treatment for MASH according to available data and recent guideline updates
• Describe the role of GLP-1 RAs in managing cardiometabolic comorbidities and their potential role in the management of MASH
PATHOPHYSIOLOGIC LINKS TO CARDIOMETABOLIC COMORBIDITIES
Sonal Kumar, MD, MPH
Identifying SLD and Its Subtypes
Are there any other causes of steatosis? Are there any other causes of steatosis? Does the patient meet any of the cardiometabolic criteria? YES NO SLD (hepatic steatosis identified by imaging or biopsy)
MASLD MetALD or other combination etiology Cryptogenic SLDa Other etiology SLD (eg, ALD, DILI, monogenic diseases)
aIf no etiology is identified; depending on clinical judgment, it could also be deemed to be possible MASLD and, thus, would benefit from periodic reassessment on a case-by-case basis. ALD, alcoholic liver disease; DILI, drug-induced liver injury; MASLD, metabolic dysfunction–associated steatotic liver disease; MetALD, metabolic dysfunction and alcohol-associated steatotic liver disease; SLD, steatotic liver disease. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986.
Cardiometabolic Criteria for MASLD
Adult Criteria (≥1)
Overweight/ Obesity
Impaired
Glucose
• BMI ≥25 kg/m2 (23 Asia) OR
• Waist circumference >94 cm (men) or 80 cm (women) OR ethnicity-adjusted equivalent
• Fasting serum glucose ≥100 mg/dL OR
• 2-hour post-load glucose level ≥140 mg/dL OR
• HbA1c ≥5.7% OR
• T2D OR treatment for T2D
Hypertension
Impaired
HDL-C
• BP ≥130/85 mm Hg OR
• Antihypertensive drug treatment
• Plasma HDL-C ≤40 mg/dL for men and ≤50 mg/dL for women OR
• Lipid-lowering treatment
Triglycerides
• Plasma triglycerides ≥150 mg/dL OR
• Lipid-lowering treatment
Pediatric Criteria (≥1)
• BMI ≥85th percentile for age/sex (BMI z score ≥+1) OR
• Waist circumference >95th percentile OR ethnicityadjusted equivalent
• Fasting serum glucose ≥100 mg/dL OR serum glucose ≥200 mg/dL OR
• 2-hour post-load glucose level ≥140 mg/dL OR
• HbA1c ≥5.7% OR
• T2D OR treatment for T2D
• Age <13 years: ≥95th percentile OR ≥130/85 mm Hg
• Age ≥13 years: 130/85 mm Hg OR antihypertensive drug treatment
• Plasma HDL-C ≤40 mg/dL OR
• Lipid-lowering therapy
• Age <10 years: plasma triglycerides ≥100 mg/dL
• Age ≥10 years: plasma triglycerides ≥150 mg/dL OR lipid-lowering therapy
Patients must meet ≥1 cardiometabolic criteria.
BP, blood pressure; HbA1c, glycated hemoglobin; HDL-C, high-density lipoprotein cholesterol. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986.
Glucose/fructose
Saturated
Linking MASLD/MASH to Obesity, T2D, and CVD
Fatty
Ceramides
Cytokines
Dysregulated
CVD, cardiovascular disease; DNL, de novo lipogenesis. Younossi ZM, et al. Clin Mol Hepatol. 2025;31(suppl):S32-S50.
Risks and Prevalence of Cardiometabolic Comorbidities in MASLD/MASH
• Prevalence in High-Risk Populations
– T2D1,2
• MASLD prevalence ~65% in people with T2D vs ~38% in general population
– Obesity2
• MASLD prevalence rises in parallel with obesity rates
• MASLD seen in 75% of patients with obesity
• MASH seen in 34% of patients with obesity
• Interplay of Disease Progression & Outcomes
– MASLD increases risk of T2D and CKD2,3
– Longer duration of T2D increases risk of advanced fibrosis3
– Poorly controlled T2D likely increases risk for fibrosis progression3
– Leading causes of death in MASH2,3
• CVD
• Complications from T2D and obesity
CKD, chronic kidney disease; CVD, cardiovascular disease.
1. Younossi ZM, et al. Clin Gastroenterol Hepatol. 2024;22(10):1999-2010.e1998; 2. Younossi ZM, et al. Clin Mol Hepatol. 2025;31(suppl):S32-S50; 3. Rinella ME, et al. Hepatology. 2023;77(5):1797-1835.
Increased Number of Cardiometabolic Factors Significantly Increases Fibrosis and Mortality Risk
Li M, et al. Nutr Metab Cardiovasc Dis. 2024;34(9):2085-2094.
Number of Cardiometabolic Factors
MASLD Progression, Management, and Comorbidities
CVD is one of the leading causes of morbidity and mortality for patients with MASH
Fat in <5% of hepatocytes
Steatosis
Steatosis
Inflammation
Ballooning
Fibrosis
Manage cardiometabolic risk factors
F, fibrosis stage; HCC, hepatocellular carcinoma.
Younossi ZM, et al. Clin Mol Hepatol. 2025;31(suppl):S32-S50.
Incorporate diet and exercise, aiming for 3% to 10% of total body weight loss
Late stage of fibrosis
Resmetirom for MASH with F2/F3
Liver transplant or death
What About MetALD?
• MetALD is a separate condition; presentation can range from more similar to MASLD or to ALD, depending on alcohol consumption1
• Patients with MetALD, particularly those with greater alcohol consumption, typically left out of clinical trials1
• Even among excessive drinkers, cardiometabolic factors are still important
– Obesity increases the prevalence of cirrhosis and presence of glycemic dysregulation that influences fibrosis severity1
Cardiometabolic Factors Increase Fibrosis and Mortality Risk in MetALD2
Number of Cardiometabolic Factors
OPTIMIZING NITS AND BIOMARKERS IN MASH DIAGNOSIS AND MONITORING
Mazen Noureddin, MD, MHSc
Who Should Be Screened for MASLD?
• General population-based screening for MASLD is not advised
• All patients with hepatic steatosis or clinically suspected MASLD based on the presence of obesity and metabolic risk factors should undergo primary risk assessment with FIB-4
• In patients with identified metabolic risk factors (or imaging evidence of hepatic steatosis), primary risk assessment with FIB-4 should be repeated every 1 to 2 years
• High-risk individuals, such as those with T2D, medically complicated obesity, family history of cirrhosis, or more than mild alcohol consumption, should be screened for advanced fibrosis using ELF, TE, or other imaging measures
Rinella ME, et al. Hepatology. 2023;77(5):1797-1835.
Use of FIB-4 in Clinical Practice
• Recommended in 2023 AASLD practice guidance as a first-line NIT1
• Important to combine with other NITs to validate findings and help eliminate gray zones, particularly prior to prescribing therapy1
Score2
Risk Category for Advanced Fibrosis
AASLD, American Association for the Study of Liver Diseases. 1. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986; 2. Hepatitis C Online. https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4.
ELF Score
• First blood test for MASH granted marketing authorization by FDA1
• Measures hyaluronic acid, tissue inhibitor of metalloproteinase-1, and N-terminal procollagen III peptide2
• Superior to FIB-4 alone for diagnosis2
• Effectively used in combination with other NITs2,3
• Score of 9.2 to 10.7 can indicate F2 or F33
– >9.8 indicates increased risk of progression to cirrhosis
FDA, US Food and Drug Administration.
1. Siemens Healthcare. https://www.siemens-healthineers.com/en-us/press-room/press-releases/elf-test-breakthrough-device-designation-diagnosis; 2. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986; 3. Miele L, et al. Int J Biol Markers. 2017;32(4):e397-e402.
Imaging Biomarkers TE and MRE
• TE measures liver stiffness1,2
– Most commonly used imaging method to detect liver stiffness and exclude fibrosis
Risk Level <8 Rule out advanced fibrosis 8-12 Potential association with fibrosis >12 High likelihood of advanced fibrosis
• MRE assesses whole liver3,4
– Highly accurate and sensitive for staging fibrosis
– Not a first-line recommendation due to limitations in access and cost kPa1,2
1. Siddiqui MS, et al. Clin Gastroenterol Hepatol. 2019;17(1):156-163.e152; 2. Hsu C, et al. Clin Gastroenterol Hepatol. 2019;17(4):630-637.e638; 3. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986; 4. Tamaki N, et al. Hepatology. 2022;75(3):661-672.
Identifying MASLD/MASH in Specialty Clinics
Primary risk assessment, eg, FIB-4 Primary Care: exclude advanced fibrosis
Gastro/Hepatology: identify/manage MASH
• Review/Perform further risk assessment, consider additional imaging
Reassess periodically
• FIB-4 every 1-2 years if T2D/preT2D or ≥2 metabolic risk factors
• FIB-4 every 2-3 years if no T2D and <2 metabolic risk factors
All patients:
• Cardiometabolic risk reduction
– lifestyle management and use of pharmacotherapy with MASLD benefit
• Assessment of alcohol intake
ALT, alanine transaminase; AST, aspartate aminotransferase. Rinella ME, et al. Hepatology. 2023;77(5):1797-1835.
follow-up or reassess
Indeterminant/High risk
Liver biopsy in certain populations
Imaging Biomarkers
TE and MRE
Imajo K, et al. Clin Gastroenterol Hepatol. 2022;20(4):908-917.e911. Stage 0 Stage 2 Stage 1 Stage 3
Imaging Biomarkers MRI-PDFF
• MRI-PDFF is highly accurate and correlates with liver histology but is expensive1,2
MRI-PDFF Examples at Different Stages of Fibrosis3
Combining NITs
• Utilizing multiple NITs that have different cutoff points can increase accuracy, although some patients will still fall in the indeterminate zone1
• ELF and TE are widely used in combination with FIB-42
– FIB-4 is easily implementable in primary care clinics
• General practice guidance recommends combining NITs to verify fibrosis stage when identifying potential candidates for pharmacotherapy2,3
1. Sterling RK, et al. Hepatology. 2025;81(2):672-724; 2. Rinella ME, et al. Hepatology. 2023;78(6):1966-1986; 3.
2024;22(12):2367-2377.
Noureddin M, et al. Clin Gastroenterol Hepatol.
Role of Liver Biopsy
• Sampling variability may be an issue1
• Typically restricted to complex cases1
– Situations of diagnostic uncertainty based on NITs
– Persistently elevated AST and ALT
– Other potential underlying cause of SLD
Still used in clinical trials1
Exploring Emerging NITs
Score Components Cutoff Notes
FAST1,2 TE + AST ≥0.67
Predictivity is largely driven by AST, and this cutoff may fail to identify many patients MAST1,3 MRI + AST
If MRE is 4.4-4.9, additional caution needed to exclude the presence of cirrhosis AGILE-3+4
ratio, platelet count, sex, diabetes status, age, TE
ratio, platelet count, sex, diabetes status, TE
FAST, FibroScan-AST; LSM, liver stiffness measure; MAST, magnetic resonance imaging-AST; PPV, positive predictive value.
F3
F4
1. Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377; 2. Newsome PN, et al. Lancet Gastroenterol Hepatol. 2020;5(4):362-373; 3. Noureddin M, et al. J Hepatol. 2022;76(4):781-787; 4. Sanyal AJ, et al. J Hepatol. 2023;78(2):247-259.
Head-to-Head Comparison of Composite Biomarkers for Detecting At-Risk MASH
aP=0.01; bP<0.001. N=245 patients with T2D and
Key Considerations for Using NITs
• Screen high-risk populations for MASLD
• Use FIB-4 as the initial screening tool
– <1.3 indicates low risk; >2.67 indicates high risk of advanced fibrosis
• Perform a 2nd test to help identify fibrosis stage
– ELF or TE
• Additional scores are available for fibrosis staging (FAST, MEFIB, etc)
Chen VL, et al. Hepatology. 2025;81(1):312-320.
RECENT ADVANCES IN MASH TREATMENT
Sonal Kumar, MD, MPH
Resmetirom
First Approved Treatment for MASH
• Resmetirom is a selective THRβ agonist1
– Directly targets the liver
– THRβ modulates genes that promote FFA uptake
– Resmetirom reduces lipotoxicity, triglycerides, and cholesterol and removes bile acid
• Resmetirom was approved in 20242
– For use in adults with MASH and F2 or F3
– No biopsy required to prescribe resmetirom THR, thyroid hormone receptor. 1. Karim G, Bansal MB. touchREV Endocrinol. 2023;19(1):60-70; 2. Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377.
Resmetirom Efficacy
Patient Eligibility for Resmetirom
STEP 3 STEP 2 STEP 11,2
Confirm MASLD and exclude other causes of liver disease
PHTN, portal hypertension.
Identify patients with confirmed or likely F2 or F3 for treatment Exclude cirrhosis
MASH with F2 or F3 OR
• TE, 8-15 kPa
• MRE, 3.1-4.4 kPa
• ELF score, 9.2-9.7 (+ second NIT)
• ELF score, 9.8-11.3 (if in isolation)
• FAST, MAST, MEFIB
Consider treatment with resmetirom AND
Cirrhosis on biopsy OR
• TE, ≥20 kPa; MRE, ≥5 kPa; ELF score, >11.3
• Platelets, ≤140,000/μL
• Evidence of PHTN, active thyroid disease, or concomitant acute liver disease
• Excess alcohol use
1. Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377; 2. Chen VL, et al. Hepatology. 2025;81(1):312-320.
Monitoring Resmetirom Safety and Efficacy
Chen VL, et al. Hepatology. 2025;81(1):312-320.
Repeat if imaging used at baseline Consider repeating if baseline data are available
Recommended for all patients
Recommended for a subset of patients for whom testing is appropriate Optional assessments based on availability
Start
resmetirom
• 80 mg if patient <100 kg
• 100 mg if patient ≥100 kg
Assessing Safety and Efficacy of Resmetirom
Assess Safety and Efficacy No response
• Worsening of NITs
• Consistent increase in ALT
Stop
Confirm safety
• Routine DILI parameters
• Tolerability
Treatment monitoring, including safety (thyroid function, lipid profile)
Benefit uncertain
• TE: <25% or MRE <20% drop in LSM
• ALT: no significant improvement
• MRI-PDFF: <30% reduction Beneficial response
• ALT: significant improvement or normalization
• TE: ≥25% or MRE: ≥20% drop in LSM
Consider continuing, addon, or alternate approach
3 Months
6 Months
12 Months
Chen VL, et al. Hepatology. 2025;81(1):312-320; Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377.
Continue
2023 AASLD Practice Guidance on GLP-1–Targeting Therapies
• Consider semaglutide or liraglutide in patients with MASH without cirrhosis due to its benefits in T2D, obesity, and CVD1 – Semaglutide has demonstrated evidence of MASH resolution and improvement in fibrosis2 • Tirzepatide may be used for patients with T2D or obesity with MASLD for its benefits in T2D and obesity1
1. Rinella ME, et al. Hepatology. 2023;77(5):1797-1835; 2. Newsome P, et al. AASLD annual meeting; November 15-19, 2024; San Diego, CA. Abstract 5018; 3. Wong ND, et al. Cardiovasc Drugs Ther. 2024. [Epub ahead of print]; 4. Loomba R, et al. N Engl J Med. 2024;391(4):299-310.
aP<0.0001.
Efficacy of Semaglutide in MASH ESSENCE Trial
SYNERGY-NASH Trial
Tirzepatide Showed Higher Rates of MASH Resolution at 52 Weeks
Combining GLP-1–Targeting Therapy With Resmetirom
• Patients taking GLP-1 RAs in the MAESTRO-NASH trial had to have stable dosing for 6 months prior to randomization1
• Insufficient data from MAESTRO-NASH to determine best strategies for combining therapies2
– Use clinical judgment to weigh fibrosis, concern for fibrosis progression, and comorbidity profile
– May need to weigh fibrosis vs severity of extrahepatic comorbidity to decide which therapy to start first
• Likely optimal to stagger initiation of resmetirom and GLP-1–targeting therapies3
1. Harrison SA, et al. N Engl J Med. 2024;390(6):497-509; 2. Chen VL, et al. Hepatology. 2025;81(1):312-320; 3. Noureddin M, et al. Clin Gastroenterol Hepatol. 2024;22(12):2367-2377.
Effect of Bariatric Surgery on MASH-Related Fibrosis
Improvement in Fibrosis Following Bariatric Surgery Among Patients With Advanced Fibrosis
Bariatric Surgery Resulted in Improved Liver Histology
Endoscopic Bariatric Weight Loss
• N=21 adults with noncirrhotic MASH, assessed 6 months post-
• Total body weight loss 11.7% ± 7.7%,
• NAS improved in 90% of patients
– Median decrease of 3 points (range, 1-4 points)
• Fibrosis improved by 1.17 stages in 15% of patients
• MRE-detected fibrosis improved by 1.5 stages in 50% of patients
Changes in NAS and Fibrosis After IGB
IGB, intragastric balloon. Bazerbachi F, et al. Clin Gastroenterol Hepatol. 2021;19(1):146-154.e144.
ADDRESSING CARDIOMETABOLIC COMORBIDITIES
Kymberly Watt, MD
• Orlistat1 – Drug interactions: warfarin, cyclosporine, and levothyroxine – No dose adjustment needed for liver disease
Phentermine + topiramate ER2
Dose adjustment if eGFR <50 mL/min or Child-Pugh B
Note: 12-week limit for phentermine use
Weight-Loss Herbal Products
Liver Toxicity
• Camellia sinensis (green tea)1 • Hydroxycut2 • Herbalife combinations3 • OxyElite Pro2 • Ma Huang (ephedra)4
• Usnic acid (lichens: Lipolyz, Lipokinetix)4
• Garcinia cambogia1
1. Farrington R, et al. J Integr Med. 2019;17(2):87-92; 2. Zheng EX, Navarro VJ. J Clin Transl Hepatol. 2015;3(2):93-98; 3. Chen GC, et al. World J Hepatol. 2010;2(11):410-415; 4. Neff GW, et al. J Hepatol. 2004;41(6):1062-1064.
Efficacy of GLP-1 RAs in Patients
With Obesity
Semaglutide Significantly Reduced Body Weight at Week 681,a Tirzepatide Significantly Reduced Body Weight at Week 722,b
Pharmacologic Therapy for Cardiometabolic Comorbidities
Post-Bariatric Surgery
• Bariatric surgery should be considered a therapeutic option1
– Surgery can reduce or resolve MASLD or MASH in patients without cirrhosis
– Surgery can decrease all-cause morbidity and mortality
• Insufficient weight loss or weight regain can occur2
• GLP-1–targeting therapies can be helpful in losing regained weight or meeting weight loss goals3
– 6 months of GLP-1 RA treatment after bariatric surgery reduced body weight by 9% and BMI by 2.9 kg/m2 (totaling two-thirds of weight regain)
1. Rinella ME, et al. Hepatology. 2023;77(5):1797-1835; 2. El Ansari W, Elhag W. Obes Surg. 2021;31(4):1755-1766; 3. Jensen AB, et al. Obes Surg. 2023;33(4):1017-1025.
Efficacy of GLP-1–Targeting Therapies in A1C Control
Utility of SGLT2i in MASH and Cardiometabolic Comorbidities
Extrahepatic Benefits Hepatic Benefits
• Glycemic control
– Weight reduction2
• SGLT1/SGLT2i >SGLT2i
• Relates to intestinal glucose uptake reduction
– ~30% to 35% RRR in CV outcomesà death, hospitalization for HF, or CVD progression3
– TG reduction but LDL elevation3
– >30% RRR of CKD1
– Neuroprotection (?)
• Antisteatosis, antioxidative stress, antifibrogenesis, anticarcinogenesis4
• Empagliflozin5
– Decreased liver stiffness
– Decrease in AST and ALT
• Canagliflozin6
– Reduced intrahepatic TG
– Reduced HCC growth (animal data)
• Dapagliflozin7
– Significant improvements in ALT, GGT, and CAP
– Patients with LSM ≥8.0 kPa showed decrease in liver stiffness
GGT, gamma-glutamyl transferase; HF, heart failure; i, inhibitor; RRR, relative risk reduction; TG, triglyceride.
1. American Diabetes Association Professional Practice Committee. Diabetes Care. 2024;47(suppl 1):S158-S178; 2. Cheong AJY, et al. Obesity (Silver Spring). 2022;30(1):117-128; 3. Forzano I, et al. Expert Opin Investig Drugs. 2023;32(9):839-847; 4. Yaribeygi H, et al. EXCLI J. 2023;22:403-414; 5. Taheri H, et al. Adv Ther. 2020;37(11):4697-4708; 6. Cusi K, et al. Diabetes Obes Metab. 2019(4);21:812-821; 7. Shimizu M, et al. Diabetes Obes Metab. 2019;21(2):285-292.
Effect of GLP-1 RAs on MACE
Semaglutide Reduced MACE in Adults With Obesity and CVD1,a Tirzepatide Predicted to Reduce Future CVD Events2,b
Mortality and Liver Transplant in MASH
Characteristic1
aP<0.001; bP=0.01; cP=0.005.
aHR, adjusted hazard ratio; CLD, chronic liver disease; OLT, outcome after liver transplantation.
1. Angulo P, et al. Gastroenterology. 2015;149(2):389-397.e310; 2. Simon TG, et al. Ann Intern Med. 2019;171(5):318-327. Death or OLT Outcome1
Statins2
• Are safe in CLD and WC cirrhosis
• Lower all-cause mortality (even in CLD)
• Reduce incidence of HCC
• Reduce liverspecific mortality (lipophilic statins; aHR, 0.76 [CI, 0.50-0.92])
The Effect of Resmetirom on Lipids MAESTRO-NASH
Key Secondary Endpoint
Pre-/Probiotic Treatment of MASLD
and Effects on Obesity and Hyperlipidemia
Prebiotic and BMI
Javadi et al (2017)
Akbarzadeh et al (2015)
Ebrahimi-Mameghani et al (2014)
Chang et al (2013)
Rocha et al (2007)
Overall
Mobini et al (2017; high)
Javadi et al (2017; pro)
Mobini et al (2017; low)
Dugan et al (2016)
Miccheli et al (2015)
Navabi et al (2014)
Alisi et al (2014)
Aller et al (2011)
Overall
aP=0.000.
Loman BR, et al. Nutr Rev. 2018;76(11):822-839.
and
Ebrahimi-Mameghani et al (2014)
Chang et al (2013)
Cho et al (2005)
Daubioul et al (2005)
Overall
Mobini et al (2017; low)
Mobini et al (2017; high)
Famouri et al (2017)
Dugan et al (2016)
Miccheli et al (2015)
Navabi et al (2014)
Aller et al (2011)
Overall
Coffee and Risk of MASLD or CVD
MASLD Presence1
Ribeiro et al 2020 6 Post-MI
Fibrosis Presence1
et al Bambha et al Zelber-Sagi et al
Shahinfar et al 2021 10 T2D
4 cups/day associated with reduced CV mortality, CHD, and CV events Ding et al 2014 5 No exclusion
Association with reduced CV mortality, no relationship with recurrent MI, stroke, or MACE
Association with reduced CV mortality in men Di Maso et al 2021 26 No exclusion
Associated with reduced CVD incidence and mortality
Observational trials support moderate coffee consumption is beneficial for CV health3 CHD, coronary heart disease; MI, myocardial infarction.
Wijarnpreecha K, et al. Eur J Gastroenterol Hepatol. 2017;29(2):e8-e12; 2. Chen Y-P, et al. Clin Nutr. 2019;38(6):2552-2557; 3. Farraj A, et al. Nutrients. 2024;16(24):4257.
Future
Investigations to Target MASH and Cardiometabolic Comorbidities
• Semaglutide + cilofexor/firsocostat1
– Phase 2 trial showed combination was well tolerated, with greater improvement in steatosis, fibrosis, and liver biochemistry vs semaglutide monotherapy
• Weight loss similar to semaglutide monotherapy
• Survodutide2,3
– Phase 2 trial showed greater rates of improvement in MASH, reduced liver fat, and improvement in fibrosis by ≥1 stage vs placebo
– Ongoing phase 3 trials
– Breakthrough therapy designation for noncirrhotic MASH
• Semaglutide + zalfermin4
– Phase 2 trial ongoing in patients with MASH and F2 to F4
1. Alkhouri N, et al. J Hepatol. 2022;77(3):607-618; 2. Sanyal A, et al. N Engl J Med. 2024;391(4):311-319; 3. Boehringer Ingelheim. https://www.boehringer-ingelheim.com/humanhealth/metabolic-diseases/survodutide-us-fda-breakthrough-therapy-phase-3-trials-mash; 4. ClinicalTrials.gov. https://clinicaltrials.gov/study/NCT05016882.
REMINDER A Resource for Clinicians
Conclusions
• MASH is a progressive disease, closely linked to numerous cardiometabolic comorbidities
• Identifying and staging fibrosis is now typically done through laboratory-, serum-, or imaging-based NITs
• Resmetirom is the first approved treatment for MASH, and is approved for use in patients with F2 or F3
• GLP-1–targeting therapies are helpful in controlling cardiometabolic comorbidities and have shown beneficial effects in MASH
• Bariatric surgery may be a viable option for managing obesity in patients with MASH