[Semaglutide and Metabolic Dysfunction-Associated Fatty Liver Disease: A Systematic Review]

Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatohepatitis (MASH) are highly prevalent conditions and represent a major public health problem.

To conduct an updated systematic review of randomized controlled trials evaluating the impact of semaglutide on hepatic outcomes in patients with MAFLD/MASH.

A systematic literature search was performed in accordance with PRISMA guidelines. Randomized, placebo-controlled clinical trials assessing the effect of semaglutide on hepatic outcomes in patients with MAFLD/MASH were included, using histological parameters and/or imaging methods.

The analyzed studies suggest a benefit of semaglutide compared with placebo in hepatic outcomes. Regarding the outcome of MASH resolution without worsening of fibrosis, consistent results were observed among studies that included liver biopsy. However, when evaluating fibrosis improvement without worsening of MASH, the results were heterogeneous. Imaging studies demonstrated a consistent benefit of semaglutide on hepatic steatosis. Nevertheless, no significant changes in liver stiffness were demonstrated. Differences in sample size, follow-up duration, and analyzed populations may explain these discrepancies.

The use of semaglutide in patients with MAFLD/MASH was associated with improvements in variables related to hepatic steatosis and, to a lesser extent, with changes in fibrosis markers. These findings should be confirmed in larger studies with longer follow-up periods.