Semaglutide for the treatment of MASH: reaching into the ESSENCE of cardio-metabolic health?

Metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis poses a significant clinical challenge, especially given its strong association with obesity and type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated impressive results in managing obesity and T2DM, prompting interest in their potential therapeutic role for MASH with fibrosis. The ESSENCE trial recently investigated the effectiveness of once-weekly semaglutide in patients with biopsy-proven MASH and moderate-to-advanced fibrosis. Interim analysis at 72 weeks demonstrated that semaglutide substantially improved liver histology, effectively resolving steatohepatitis and showing improvement in liver fibrosis, compared to placebo. Consistent with these findings, the U.S. Food and Drug Administration has granted accelerated approval to semaglutide (Wegovy) for adults with noncirrhotic MASH and stage 2 or 3 fibrosis. Those hepatic benefits were accompanied with notable improvements in body weight, insulin sensitivity and inflammatory markers. While these preliminary results are encouraging, their clinical relevance will depend on whether they translate into reduced long-term liver complications and amelioration of overall cardio-renal risk. Thus, semaglutide represents a highly promising therapeutic strategy for patients with MASH and fibrosis, addressing critical unmet needs by simultaneously targeting liver pathology and cardiometabolic health.