Practice Signal
This review helps pharmacists position resmetirom, semaglutide, and emerging incretin agents against updated AASLD and EASL guidance for noncirrhotic MASH with fibrosis.
For noncirrhotic MASH with F2-F3 fibrosis, two agents are now FDA-approved with high-quality histologic evidence, resmetirom (a liver-targeted THR-beta agonist) and semaglutide 2.4 mg (a metabolically active GLP-1 receptor agonist), and pharmacists can guide selection using noninvasive test thresholds, comorbidity fit, and drug-interaction and monitoring profiles.
Metabolic dysfunction-associated steatohepatitis (MASH, formerly nonalcoholic steatohepatitis, NASH) moved from having no approved pharmacotherapy to two FDA-approved options within roughly 18 months: resmetirom (Rezdiffra) in March 2024 and semaglutide 2.4 mg (Wegovy) in August 2025, both for noncirrhotic disease with moderate-to-advanced (F2-F3) fibrosis. Both approvals rest on centrally read paired-biopsy histologic surrogate endpoints (steatohepatitis resolution and fibrosis improvement), with hard liver-outcome confirmation still pending. Investigational dual and triple incretin agents, including tirzepatide and survodutide, are advancing through the pipeline behind them.
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