Hormonal
Resmetirom (80-100 mg daily) improves histological MASH resolution and fibrosis in patients with F2-F3 fibrosis without requiring significant weight loss, while also lowering LDL cholesterol.
If you have moderate to advanced liver scarring (F2-F3) from metabolic issues, Resmetirom is a new daily pill option. It works by targeting liver-specific thyroid receptors to reduce inflammation and scarring, and it also lowers bad cholesterol. You do not need to lose a lot of weight for it to work on the liver, though diet and exercise are still recommended.
Resmetirom 80 mg and 100 mg achieved MASH resolution in significantly higher proportions than placebo: 25.9% and 29.9% respectively, vs. 9.7% with placebo... Similarly, significantly higher proportions achieved fibrosis improvement by at least one stage without worsening of MASH: 24.2% and 25.9% respectively, vs. 14.2% with placebo... These histological improvements occurred without significant weight loss (-1.8 kg to -1.2 kg in treated arms vs. -0.87 kg with placebo)... LDL cholesterol was significantly reduced after 24 weeks compared with placebo: -12% and -16% in the 80 mg and 100 mg arms respectively, vs. + 1% with placebo
Why this rating
Based on Phase 3 randomized, double-blind, placebo-controlled trial (MAESTRO-NASH).
Source
AISF practice guidance on pharmacological treatment of metabolic-dysfunction associated steatotic liver disease and steatohepatitis (MASLD/MASH): A 2026 Update
Alessio Aghemo et al. · Digestive and Liver Disease · 2026
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