Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma

ABSTRACT The Paris International Liver Meeting (January 19–21, 2026) brought together leading hepatology experts to discuss transformative advances in chronic liver disease management. The meeting highlighted pivotal developments reflecting the field's evolution from disease characterisation toward precision, mechanism‐based therapeutics. Metabolic dysfunction‐associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction‐associated steatohepatitis (MASH), were highlighted, marking the transition to an era of approved disease‐modifying therapies. Resmetirom and semaglutide are now approved for MASH with F2–F3 fibrosis, with a robust pipeline generating anti‐fibrotic signals through FGF21 analogs, pan‐peroxisome proliferator‐activated receptor (PPAR) agonists, and incretin‐based dual and triple agonists. Non‐invasive tests have evolved beyond their original diagnostic role to enable prognostic stratification, screening of at‐risk populations, treatment selection, and monitoring of therapeutic response. This evolution is not limited to MASLD, but extends to other chronic liver diseases, including primary biliary cholangitis (PBC) and portal hypertension, as highlighted by the recommendations of the Baveno Consensus Workshops. Hepatitis B and D are moving toward functional cure strategies, with simplified HBV treatment algorithms based on fibrosis and viral load, supported by biomarkers for risk stratification and safe treatment discontinuation. In parallel, HDV management is transitioning from a severe disease to one with emerging suppressive and potential curative l through bulevirtide and novel HBsAg‐targeting and RNA‐silencing therapies, respectively. Management of PBC has advanced with novel PPAR agonists that improve cholestatic biochemistry and pruritus, supported by individualised risk stratification. However, significant treatment gaps persist, with fewer than half of eligible PBC patients receiving second‐line therapy, and fatigue remains a major unmet clinical need. Furthermore, effective pharmacotherapies for primary sclerosing cholangitis (PSC) remain a major challenge, and no approved disease‐modifying treatments are currently available. Finally, for patients with hepatocellular carcinoma (HCC), immunotherapy combinations can achieve unprecedented long‐term survival in selected populations of patients. Collectively, these advances define a new era of hepatology centered on precision medicine, earlier intervention, and mechanism‐driven therapeutic strategies.

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Journal
Liver International
Published
2026-08-18
DOI
https://doi.org/10.1111/liv.70806
Primary Topic
Liver Disease Diagnosis and Treatment
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article
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article

Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma

Valérie Vilgrain, Markus Cornberg, Paolo Angeli, Tarik Asselah et al.
Liver International
Liver Disease Diagnosis and Treatment
article

Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma

Valérie Vilgrain, Markus Cornberg, Paolo Angeli, Tarik Asselah, Laurent Castéra, Claire Francoz, Emmanuel Tsochatzis, Debbie L. Shawcross, Sabela Lens, François Durand, Olivier Roux, Paul Brennan, Élise Vuille‐Lessard, Mark R. Thursz, Adrian Carlos Gadano, Shira Zelber‐Sagi, George Papatheodoridis, Mads Israelsen, Cyrielle Caussy, Elisabetta Bugianesi, Pierre‐Emmanuel Rautou, Jean–François Gautier, Maurice Stephan Michel, Jean–Michel Pawlotsky, Ana Lleò, Thomas Mouillot, Hannes Hagström, Alessio Aghemo, Maja Thiele, Lorenza Rimassa, YUSUF YILMAZ, Lucia Parlati, Massimo Pinzani, Pere Ginès, Christophe Moreno, Sven Francque, D. I. Jones, Claire Carette, Thomas Reiberger, Zobair M. Younossi, Elisabetta Degasperi, Andreas Emanuel Kremer, Frank Tacke, Nicola Riccardo Pugliese, Helena Hernández-Évole, Jörn M. Schattenberg, Michael Betel, Vincent Wai‐Sun Wong, Ramón Bataller, María Buti, Jean‐François Dufour, Pietro Lampertico, Josep M. Llovet, Lawrence Serfaty, Dominique Thabut, Vlad Ratziu, Michael Trauner, Maurizia Brunetto, Jérôme Boursier, David J. Pinato, Annalisa Berzigotti, Mazen Noureddin
article en

Abstract

ABSTRACT The Paris International Liver Meeting (January 19–21, 2026) brought together leading hepatology experts to discuss transformative advances in chronic liver disease management. The meeting highlighted pivotal developments reflecting the field's evolution from disease characterisation toward precision, mechanism‐based therapeutics. Metabolic dysfunction‐associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction‐associated steatohepatitis (MASH), were highlighted, marking the transition to an era of approved disease‐modifying therapies. Resmetirom and semaglutide are now approved for MASH with F2–F3 fibrosis, with a robust pipeline generating anti‐fibrotic signals through FGF21 analogs, pan‐peroxisome proliferator‐activated receptor (PPAR) agonists, and incretin‐based dual and triple agonists. Non‐invasive tests have evolved beyond their original diagnostic role to enable prognostic stratification, screening of at‐risk populations, treatment selection, and monitoring of therapeutic response. This evolution is not limited to MASLD, but extends to other chronic liver diseases, including primary biliary cholangitis (PBC) and portal hypertension, as highlighted by the recommendations of the Baveno Consensus Workshops. Hepatitis B and D are moving toward functional cure strategies, with simplified HBV treatment algorithms based on fibrosis and viral load, supported by biomarkers for risk stratification and safe treatment discontinuation. In parallel, HDV management is transitioning from a severe disease to one with emerging suppressive and potential curative l through bulevirtide and novel HBsAg‐targeting and RNA‐silencing therapies, respectively. Management of PBC has advanced with novel PPAR agonists that improve cholestatic biochemistry and pruritus, supported by individualised risk stratification. However, significant treatment gaps persist, with fewer than half of eligible PBC patients receiving second‐line therapy, and fatigue remains a major unmet clinical need. Furthermore, effective pharmacotherapies for primary sclerosing cholangitis (PSC) remain a major challenge, and no approved disease‐modifying treatments are currently available. Finally, for patients with hepatocellular carcinoma (HCC), immunotherapy combinations can achieve unprecedented long‐term survival in selected populations of patients. Collectively, these advances define a new era of hepatology centered on precision medicine, earlier intervention, and mechanism‐driven therapeutic strategies.

Liver InternationalVol. 46(9)
University of Pisa (IT), Délégation Paris 5 (FR), University of Bern (CH), Institució Catalana de Recerca i Estudis Avançats (ES), Hebron University (PS), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), Houston Methodist (US), Université Libre de Bruxelles (BE), Karolinska University Hospital (SE), Humanitas University (IT), University of Padua (IT), Inserm (FR), Recep Tayyip Erdoğan University (TR), King's College - North Carolina (US), Université de Bourgogne (FR), Chinese University of Hong Kong (HK), Georgetown University (US), Université Paris-Est Créteil (FR), Université Paris Cité (FR), Hôpital Beaujon (FR), Paris-Est Sup (FR), University Hospital of Bern (CH), The Royal Free Hospital (GB), Odense University Hospital (DK), Hammersmith Hospital (GB), Hospital Italiano de Buenos Aires (AR), Ninewells Hospital (GB), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Karolinska Institutet (SE), Medizinische Hochschule Hannover (DE), Sorbonne Université (FR), Ospedale Maggiore (IT), Barcelona Graduate School of Mathematics (ES), Sorbonne Paris Cité (FR), Hôpital Cochin (FR), Toronto Dementia Research Alliance (CA), Assistance Publique – Hôpitaux de Paris (FR), University Hospital of Zurich (CH), Hospices Civils de Lyon (FR), Antwerp University Hospital (BE), Methodist Hospital (US), Hôpital Lyon Sud (FR), Laiko General Hospital of Athens (GR), Hospital Clínic de Barcelona (ES), Hôpital Lariboisière (FR), Pitié-Salpêtrière Hospital (FR), Center for Outcomes Research in Liver Diseases (US), Vall d'Hebron Hospital Universitari (ES), Department of Medical Sciences (BY), Centre de Recherche sur l'Inflammation (FR), Global Health Council (US), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), NIHR Newcastle Biomedical Research Centre (GB), Centre For Digestive Diseases (AU), Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), IRCCS Humanitas Research Hospital (IT), Hôpital Civil, Strasbourg (FR), University College London (GB), Imperial College London (GB), Université d'Angers (FR), Universitat de Barcelona (ES), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), University of Haifa (IL), Saarland University (DE), Icahn School of Medicine at Mount Sinai (US)
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Liver Disease Diagnosis and Treatment
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