Tirzepatide use in adolescents with metabolic dysfunction-associated steatotic liver disease (MASLD): A case series

Pediatric obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence has risen markedly over the past decade. Due to transition delays and workforce shortages, pediatric specialists often manage patients into young adulthood, and thus familiarity with adult pharmacotherapies for MASLD is essential. Currently, Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is approved for adults with metabolic dysfunction-associated steatohepatitis (MASH) and F2-F3 fibrosis; however, dual and triple agonists are being evaluated. Tirzepatide, a dual agonist that targets gastric inhibitory peptide (GIP) and the GLP-1 receptor, has demonstrated superior weight reduction to Semaglutide (-20.2% vs. -13.7%) with a more favorable gastrointestinal adverse effect profile. Adult literature has demonstrated its effectiveness in MASH resolution, and pediatric data suggest it is safe in younger populations. Currently, there are no pediatric/adolescent studies exploring the use of Tirzepatide in MASLD. We present our experience using Tirzepatide in two adolescent patients with obesity and MASLD.