Semaglutide works wonders in MASH, MASLD

Use of semaglutide results in steatohepatitis resolution and improved biochemical and imaging markers among patients with metabolic dysfunction-associated steatotic liver disease (MASLD), results of a meta-analysis have shown.

“However, its antifibrotic efficacy appears stage-dependent and time-dependent, with significant histological reversal primarily observed in noncirrhotic stages within current trial durations,” the investigators said.

Databases were searched through 8 January 2026 following the PRISMA guidelines, yielding 10 eligible studies including a total of 1,908 participants. The primary outcomes were histological metabolic dysfunction-associated steatohepatitis (MASH) resolution and fibrosis improvements. Other outcomes assessed were liver stiffness and biochemical markers.

Semaglutide resolved MASH without worsening fibrosis (odds ratio [OR], 3.48, 95 percent confidence interval [CI], 2.68‒4.53; p<0.00001). However, pooled fibrosis improvement (≥1 stage) did not reach statistical significance (OR, 1.17, 95 percent CI, 0.49‒2.80; p=0.72).

Semaglutide use also resulted in reduced liver stiffness (mean difference, ‒1.25 kPa, 95 percent CI, ‒2.18 to ‒0.32; p=0.009) and increased relative liver fat reduction of ≥30 percent (OR, 7.16, 95 percent CI, 3.08‒16.64; p<0.00001). Levels of aspartate aminotransferase, alanine aminotransferase, and cholesterol also decreased significantly.

With regard to safety, semaglutide use correlated with an increased risk of gastrointestinal-related adverse events (risk ratio [RR], 1.83, 95 percent CI, 1.20‒2.79) compared with the control group. However, no significant between-group difference was seen in the risk of serious adverse events (RR, 1.07, 95 percent CI, 0.82‒1.39).