Hormonal
Semaglutide significantly improves MASH resolution and reduces liver steatosis and enzymes, but does not significantly improve fibrosis regression, with efficacy increasing at doses ≥2.0 mg/week and durations ≥12 months.
If you have MASH, semaglutide is a strong option to resolve active liver inflammation and reduce liver fat, especially if you can tolerate doses of 2.0 mg/week or higher for at least a year. However, do not expect it to reverse existing liver scarring (fibrosis). The primary benefit is halting active injury and reducing metabolic risk factors like weight and blood sugar, which indirectly protects the liver.
Semaglutide significantly improved MASH Resolution (RR = 1.98, 95%CI: 1.57 to 2.50) but did not yield significant improvement in Fibrosis Regression (RR = 1.18, 95%CI: 0.74 to 1.88). Semaglutide also reduced Liver Steatosis (WMD = -11.30%, 95%CI: -18.70 to -3.91) and the Enhanced Liver Fibrosis (ELF) score (WMD = -0.49, 95%CI: -0.70 to -0.29)... Significant reductions were observed in liver enzymes, including alanine aminotransferase (ALT; WMD = -5.55 U/L, 95%CI: -9.21 to -1.89) and aspartate aminotransferase (AST; WMD = -3.85 U/L, 95%CI: -7.67 to -0.03)... Subgroup analyses revealed the greatest benefits in patients receiving higher doses (≥ 2.0 mg weekly) and longer intervention durations (≥12 months).
Why this rating
Meta-analysis of 22 RCTs with over 32,000 patients, using rigorous PRISMA and GRADE methodologies.
Source
The impact of semaglutide on liver outcomes in patients with or at risk of MASH: a dose and duration response meta-analysis of randomized trials
Ranran Kan et al. · Diabetology & Metabolic Syndrome · 2025
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