Metabolic-associated fatty liver disease (MASLD) is characterized by fat accumulation in the liver and is linked to conditions like obesity and type 2 diabetes. Its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), can lead to liver fibrosis, cirrhosis, or cancer.
Recently, both the FDA and EMA have approved resmetirom and semaglutide for treating MASH without cirrhosis, particularly in cases with moderate to high fibrosis. These treatments are complemented by lifestyle changes and management of other metabolic conditions.
To facilitate the clinical implementation of these therapies, Dr. Andreea Ciudin, a researcher at Vall d'Hebron Institute of Research (VHIR) and coordinator of the Comprehensive Obesity Treatment Unit at Vall d'Hebron University Hospital, has contributed to a European clinical guide. This document, published in the Journal of Hepatology, is a collaboration between the European Association for the Study of the Liver (EASL), the European Association for the Study of Obesity (EASO), and the European Association for the Study of Diabetes (EASD).
The guide offers healthcare professionals recommendations for identifying eligible patients, selecting the most appropriate treatment based on individual characteristics, and establishing protocols for implementation and long-term follow-up.
“"In the guide, we emphasize that treatments must be individualized according to each person's risks and characteristics, including the presence of obesity, type 2 diabetes, and other cardiovascular, renal, or metabolic alterations."
Semaglutide is particularly recommended for MASH patients with obesity, type 2 diabetes, or cardiovascular issues due to its cardiometabolic benefits. Resmetirom is prioritized for those without obesity or who do not tolerate semaglutide.
The guide also addresses monitoring treatment safety and efficacy, highlighting the importance of tracking nutritional status and maintaining muscle mass during therapy.
This guide was developed based on an analysis of available scientific literature and with input from healthcare professionals, patient representatives, and other experts in MASH.
