Early Adoption and Prescribing Patterns of Resmetirom: A Multi-Institutional National Analysis

Resmetirom received FDA approval in March 2024 as the first therapy for noncirrhotic MASH with moderate-to-advanced fibrosis. This retrospective cohort study used the TriNetX Research Network to assess early prescribing patterns among 3712 patients across 44 healthcare organisations. The mean age was 57.6 years, 57% were female, and the mean BMI was 33.9 kg/m². The cohort was predominantly White (73.8%), with representation from Hispanic/Latino (11.7%) and Asian (8.1%) populations. MASLD and MASH diagnoses were documented in 72% and 56% of patients, while 15% carried cirrhosis codes. Common comorbidities included dyslipidaemia (55%), hypertension (52%) and type 2 diabetes (41%). GLP-1 receptor agonists were commonly prescribed, with semaglutide (n = 1124), tirzepatide (n = 842), dulaglutide (n = 391) and liraglutide (n = 203) representing the most frequently used agents. Among 19 643 treatment-eligible patients (1057 treated and 18 586 untreated), 5.4% received resmetirom. Treated patients were more frequently Asian or Hispanic and more likely to be prescribed GLP-1 receptor agonists, statins, metformin or ARBs (all p < 0.01). Early prescribing demonstrates preferential use among individuals with higher metabolic burden but reveals potential miscoding or off-label use and significant underutilization among eligible populations.