Hormonal
Dual and triple receptor agonists (Tirzepatide, Survodutide, Retatrutide) show promise in MASH resolution, with some demonstrating superior efficacy to single GLP-1 agonists in weight loss and MASH resolution, though long-term hepatic outcomes are still being established.
Newer multi-agonist drugs like Tirzepatide (5-15mg weekly) show strong results in resolving MASH and improving fibrosis in Phase 2 trials, often matching or exceeding the efficacy of single GLP-1 agonists. Patients should discuss access and cost with their providers, as these are newer, expensive therapies with robust but still maturing long-term data.
Dual receptor agonism approaches are also showing promise in phase 2 trials of MASH with both Tirzepatide (a dual GLP1/GIP agonist) and Survodutide (a dual GLP1/Glucagon receptor agonist) meeting their primary end-points of remitting steatohepatitis without worsening of fibrosis and improvement in fibrosis stage of ≥ 1 grade without worsened steatohepatitis when compared with placebo
Why this rating
Based on Phase 2 trials (SYNERGY-NASH, Survodutide Phase 2); Phase 3 data for long-term outcomes is still awaited.
Source
The promise of incretin-based pharmacotherapies for metabolic dysfunction-associated fatty liver disease
Harendran Elangovan et al. · Hepatology International · 2025
DOI 10.1007/s12072-025-10795-6
More from this paper
- Incretin-based pharmacotherapies (GLP-1, GIP, and triple agonists) significantly improve metabolic dysfunction-associated steatohepatitis (MASH) resolution and fibrosis regression compared to placebo, primarily through weight loss and insulin sensitization, with some agents showing direct hepatic benefits.Good
- Incretin therapies are associated with gastrointestinal side effects and potential risks of gallstone disease and pancreatitis, requiring careful patient selection and monitoring, particularly in those with a history of these conditions.Good
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