Weight-loss drugs are increasingly becoming part of the treatment arsenal for metabolic dysfunction-associated steatotic liver disease (MASLD), offering new options for patients with specific forms of the condition.
According to Professor Erifili Chatziaggelaki, professor of Internal Medicine and Metabolic Diseases at the National and Kapodistrian University of Athens and the European University Cyprus, lifestyle changes remain the cornerstone of treatment, but new injectable therapies are creating additional opportunities for selected patients.
New treatments for selected patients
Medicines originally developed for diabetes and obesity are now attracting attention for their potential role in treating liver disease.
Weekly injectable therapies are already in use, while newer dual-agonist drugs are showing promising results in clinical studies.
Semaglutide has been approved by the US Food and Drug Administration (FDA) for adults with metabolic dysfunction-associated steatohepatitis (MASH) and moderate-to-advanced fibrosis without cirrhosis.
Chatziaggelaki stressed that this approval applies to a specific group of patients and does not represent a general approval for all cases of fat accumulation in the liver.
She also highlighted recent studies presented at the European Association for the Study of Diabetes congress in Milan on survodutide, a dual-agonist injectable treatment targeting diabetes, obesity and liver steatosis.
A "silent" disease affecting nearly four in 10
The condition, now known as metabolic dysfunction-associated steatotic liver disease, involves fat accumulation in the liver alongside at least one cardiometabolic risk factor, such as:
- Obesity
- Diabetes
- Hypertension
- Lipid disorders
According to figures cited by Chatziaggelaki, the disease affects approximately 38% of the global population.
In some patients it can progress to steatohepatitis, fibrosis and eventually cirrhosis.
One of the main challenges is that the disease often develops without noticeable symptoms. Even people with significant fibrosis may have no specific complaints, while normal liver enzyme levels do not necessarily rule out advanced disease.
Normal weight does not rule out fatty liver
Chatziaggelaki noted that fatty liver disease can also occur in people who are not obese.
Factors contributing to the condition include:
- Insulin resistance
- Genetic predisposition
- Diet
- Physical activity levels
- Fat distribution within the body
She emphasised that a person's metabolic profile is more important than weight alone when assessing risk.
The relationship between diabetes and fatty liver disease is also bidirectional. Insulin resistance promotes fat accumulation in the liver, while liver steatosis itself is linked to an increased risk of developing diabetes.
Diagnosis and monitoring
Investigation typically includes:
- Blood tests
- Specialised risk-score calculations
- Ultrasound scans
- Elastography to assess liver stiffness and fibrosis
- Biopsy in selected cases
Regular screening is particularly important for people with diabetes, obesity, hypertension or abnormal lipid levels.
Lifestyle remains key
Despite advances in drug treatments, Chatziaggelaki stressed that diet, exercise and weight loss remain the foundation of treatment.
She noted that losing more than 7-10% of body weight can significantly improve liver steatosis.
Alcohol consumption also requires attention, as alcohol can contribute to fat accumulation in the liver.
According to the professor, the disease can often be substantially improved, particularly when diagnosed early and managed through sustained lifestyle changes, with medication added where appropriate.
She said early diagnosis and consistent follow-up remain crucial in preventing progression and improving outcomes.
Source: ANA-MPA
