Guideline Update: Semaglutide Therapy for Metabolic Dysfunction-Associated Steatohepatitis: November 2025 updates-Guideline Update: Semaglutide Therapy for Metabolic Dysfunction-Associated Steatohepatitis: November 2025 updates

Guideline Update: Semaglutide Therapy for Metabolic Dysfunction-Associated Steatohepatitis: November 2025 updates

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Video Summary

Dr. Meena Bansal discusses the 2025 clinical guidance for using semaglutide to treat MASH with moderate-to-advanced fibrosis. FDA accelerated approval followed interim results from the phase 3 ESSENCE trial: at 72 weeks, MASH resolution without worsening fibrosis occurred in 63% of treated patients versus 34% on placebo, while fibrosis improved by at least one stage in 37% versus 22%. Full approval awaits evidence of fewer liver-related clinical events.<br /><br />Guidance focuses on selecting patients with F2–F3 fibrosis using noninvasive tests such as VCTE, ELF, or MRE; biopsy is generally reserved for uncertain diagnoses. Treatment is not approved for MASH cirrhosis, though semaglutide may be used for other indications in compensated cirrhosis with attention to protein intake and resistance exercise to limit muscle loss.<br /><br />Common adverse effects include nausea and constipation. Bansal recommends gradual dose escalation, counseling on symptom management, and follow-up to assess tolerance, liver markers, nutrition, and exercise. Responders generally remain on treatment because MASH is chronic and weight regain after stopping is common. Future priorities include predicting which therapy will work best, studying combination approaches, and evaluating emerging drugs and benefits beyond the liver.

Keywords

semaglutide

MASH

moderate-to-advanced fibrosis

ESSENCE trial

VCTE

ELF

MRE