The US Food and Drug Administration (FDA) has officially approved semaglutide, a drug widely known for weight loss and diabetes control, for treating metabolic associated steatohepatitis (MASH). This approval marks a major advancement in liver disease treatment, as MASH is a progressive condition caused by fat buildup and inflammation in the liver. Often symptomless in its early stages, the disease can silently progress to cirrhosis, liver failure, or liver cancer if untreated. By targeting both weight reduction and liver health, semaglutide offers a dual benefit for patients at high risk. Experts see this as a breakthrough, providing the first effective pharmacological option for millions affected by fatty liver disease, which is rapidly emerging as a global health concern.These results suggest semaglutide is not just managing risk factors like weight and blood sugar but is directly improving liver health, offering new hope for patients who previously had no effective drug treatment options.
What is MASH? Understanding the fatty liver disease
MASH (previously called non-alcoholic steatohepatitis or NASH) is a severe form of fatty liver disease. It usually begins as metabolic-associated fatty liver disease (MAFLD), where fat gradually builds up in the liver due to poor metabolism.
- Early stage (MAFLD): Excess fat is stored in the liver but often without symptoms.
- Progression to MASH: Over time, fat accumulation triggers inflammation and cell injury.
- Advanced stage (Fibrosis and Cirrhosis): Continuous inflammation leads to scarring (fibrosis), which reduces liver function. Severe scarring, known as cirrhosis, may result in liver failure or cancer.
Why early detection is difficult
Most patients remain unaware of MASH because symptoms develop only in later stages. When present, they may include:
- Abdominal discomfort or pain
- Fatigue and low energy
- Loss of appetite and weight loss
- Jaundice (yellowing of eyes and skin)
This makes screening and preventive treatment crucial, especially for people who are overweight, diabetic, or have high cholesterol.
MASH and obesity: How Semaglutide is changing liver disease treatment
MASH is closely linked to obesity, diabetes, and metabolic syndrome. With the rise of these conditions globally, MASH has become one of the leading causes of chronic liver disease.Until recently, doctors only recommended lifestyle interventions such as diet control, weight loss, and regular exercise. In 2023, the FDA approved Resmetirom, the first medicine for MASH. Now, semaglutide’s approval adds another option — but with a different working mechanism. Semaglutide belongs to a class of drugs known as GLP-1 receptor agonists. It was first approved in 2017 for type 2 diabetes and later for obesity management and heart disease prevention.In MASH patients, semaglutide helps by:
- Reducing body weight and abdominal fat, which lowers liver fat storage
- Improving insulin resistance, a key factor in fatty liver buildup
- Lowering systemic inflammation, reducing liver injury
This makes semaglutide particularly useful in patients who have both obesity and fatty liver disease.
Source: The New York Times
FDA approves semaglutide medication for MASH after strong clinical trial results
The FDA based its approval on results from a large phase III clinical trial involving 800 participants across multiple centers.
- 534 patients received semaglutide; 266 received a placebo.
- After 72 weeks, results showed:
- 63% of patients on semaglutide had resolution of MASH without worsening liver scarring.
- Only 34% in the placebo group achieved the same.
When looking at liver fibrosis (scarring):
- 37% of semaglutide users showed improvement, compared to 22% in the placebo group.
- The trial is ongoing for 240 weeks (around 4.5 years) to determine whether these improvements can lower risks of death, liver transplant, or severe complications.
MASH in India: A growing health challenge
India is witnessing a rapid increase in metabolic liver diseases, driven by rising obesity, sedentary lifestyles, and high rates of diabetes.As reported, studies estimate that 9% to 32% of Indians may be living with MAFLD, the starting point of MASH.A 2025 study of IT employees in Hyderabad revealed alarming trends:
- 84% had excess liver fat
- 76.5% had high cholesterol levels
- 70.7% were obese
- 20.9% had elevated fasting blood sugar
These numbers reflect the strong connection between urban lifestyles, poor diet, and fatty liver disease in India’s working population.Also Read |
