UC expert weighs in on current MASH treatment approaches
He says pharmacotherapy pipeline is rapidly evolving
As MedCentral recently reported, pending broader pharmacologic approvals for metabolic dysfunction-associated steatohepatitis (MASH), lifestyle modifications remain the go-to intervention.
However, the MASH pharmacotherapy pipeline is expanding, said Adam Myer, MD, a faculty member in the University of Cincinnati College of Medicine.
“The MASH pharmacologic landscape has evolved rapidly over the past several years and is now entering a highly active therapeutic era, with FDA-approved therapies alongside a robust pipeline of investigational agents,” Myer, an assistant professor of clinical medicine in the Division of Gastroenterology and Hepatology in the Department of Internal Medicine, told MedCentral.
The U.S. Food and Drug Administration (FDA) approved the first treatment for MASH, resmetirom, in March 2024, followed by semaglutide in August 2025. The MASH pharmacotherapy research pipeline is now dominated by metabolic and incretin-based agents, with additional combination trials and late-stage programs targeting fibrosis, lipogenesis and thyroid hormone signaling.
Myer, who is also a UC Health transplant hepatologist, pointed out that the two FDA-approved medications are indicated for patients with MASH and moderate-to-advanced fibrosis (F2–F3). Thus, “there remains a significant unmet need in patients with cirrhotic (F4) MASH, for which no FDA-approved therapies are currently available,” he said.
Myer emphasized that weight loss is clearly a major driver of histologic improvement in MASH, particularly for steatosis and fibrosis, and underpins much of the benefit observed with GLP-1 therapies.
“Several next-generation dual- and triple-agonists are in development with the potential of greater efficacy in weight reduction and potentially enhanced hepatic outcomes,” he said, “but head-to-head data and long-term safety will ultimately determine their clinical positioning.”
Myer said the MASH therapeutic landscape is expected to evolve toward a more personalized, combination-based treatment paradigm during the next five to 10 years.
“Finally, as more agents become available, clinical algorithms will increasingly incorporate both noninvasive biomarkers and histologic endpoints to guide therapy initiation and escalation and prevent progression to cirrhosis and liver-related complications,” he said.
Featured image at top: Unsplash.
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