[Current and future medical treatments for metabolic dysfunction-associated steatohepatitis]

Drug treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) is undergoing a revolution. The fight against cardiovascular risk factors, the optimization of the treatment of type 2 diabetes, the screening of common extra-hepatic cancers, personalized dietary measures, therapeutic physical exercise programs and the fight against a sedentary lifestyle remain fundamental to propose to all patients. For patients with metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis (F2-F3), resmetirom is the first effective and well-tolerated drug marketed in the USA and Europe. Semaglutide or double or triple incretin receptor/glucagon receptor agonists could constitute the future cornerstone of drug management for patients with MASLD, due to the achievement of very significant weight loss (from 10 to more than 24% of the initial weight). Semaglutide has been shown to reduce cardiovascular and renal events, and has been approved for marketing in the USA, for MASH without cirrhosis. The choice of the best drug combination, the optimal prescription duration and the best drug option in the case of MASH-related cirrhosis remain to be determined.