Pharmacologic Treatments for Metabolic Dysfunction-Associated Steatohepatitis

Metabolic dysfunction-associated steatohepatitis (MASH), formerly known as non-alcoholic steatohepatitis (NASH), is a progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) and a part of the larger spectrum of liver disease. MASH is differentiated from other causes of steatohepatitis by the presence of metabolic dysfunction and exclusion of excessive alcohol intake. The clinical burden of MASH is related not only to the risk of cirrhosis and hepatocellular carcinoma, but also cardiovascular disease, chronic kidney disease, type 2 diabetes, and extrahepatic cancers. Although lifestyle modifications are the primary treatments for MASH, pharmacotherapeutic options are promising. Resmetirom, a liver-directed thyroid hormone receptor beta-selective agonist, was the first agent to receive FDA approval in adults with noncirrhotic MASH and moderate to advanced fibrosis in March 2024. This approval was quickly followed by the approval of semaglutide for the same indication in August 2025.