MASLD treatment-a shift in the paradigm is imminent

Area of Science:

• Hepatology
• Endocrinology
• Metabolic Diseases

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent and a leading cause of end-stage liver disease.
• Current effective treatments primarily focus on weight loss, with interventions evolving from lifestyle changes to surgical and endoscopic procedures.
• The emergence of novel anti-obesity medications rivals bariatric surgery in efficacy, signaling a shift in management strategies.

Purpose of the Study:

• To review the evolving landscape of MASLD treatment.
• To highlight the necessity of liver-targeted therapies for patients with liver fibrosis.
• To forecast upcoming disruptive changes in MASLD management.

Main Methods:

• Literature review of current and emerging MASLD treatments.
• Analysis of the impact of weight loss interventions, including lifestyle, surgery, endoscopy, and pharmacotherapy.
• Assessment of the role of liver-directed therapies in advanced MASLD.

Main Results:

• Weight loss remains the cornerstone of MASLD treatment.
• Pharmacological anti-obesity agents are becoming competitive with bariatric surgery.
• Liver-targeted therapies are crucial for patients with established fibrosis.

Conclusions:

• The treatment paradigm for MASLD is rapidly advancing.
• A future shift in MASLD treatment comparable to direct antiviral agents for hepatitis C is anticipated.
• Integrated approaches combining weight management and liver-specific treatments will be key.