Metabolic dysfunction-associated steatotic liver disease: Integrating metabolic and hepatic management into pharmacy...

The purpose of this manuscript is to provide an up-to-date overview of the emerging pharmacotherapy options for the treatment and management of metabolic dysfunction-associated steatotic liver disease (MASLD) while also highlighting pathophysiology, diagnostic criteria, risk factors, management of comorbidities, and implications for pharmacist practice.

MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), affects approximately 80 million adults in the US and disproportionately impacts individuals with diabetes and obesity. Recent guidance from the AASLD, ADA, and AACE provides a framework for screening, diagnosis, and pharmacological management aimed at reducing fibrosis, hepatic steatosis, and inflammation. Updated recommendations emphasize risk stratification through noninvasive testing, such as the FIB-4 score, followed by noninvasive imaging when clinically indicated. Fibrosis staging informs subsequent treatment decisions, which may include pharmacological agents such as PPAR agonists (pioglitazone), antioxidants (vitamin E), thyroid hormone receptor-β agonists (resmetirom), and GLP-1 or GLP-1/GIP receptor agonists. While pharmacotherapy plays an essential role in management, lifestyle interventions and comprehensive patient education remain fundamental components of care.

As treatment options for MASLD continue to emerge, it is crucial for pharmacists across all practice settings to optimize patient care. Optimization should occur through early recognition and management of comorbidities and disease, as well as by ensuring access to medications. Effective management of MASLD involves collaboration among all members of the healthcare team to enhance patient outcomes and maintain safety.