Major Advancement in MASH Management

In this insightful and practical lecture, Dr. Brown dives into the evolving landscape of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, with a focus on early detection, non-invasive fibrosis staging, and new therapeutic strategies. Drawing on clinical data and real-world experience, the presentation highlights the growing burden of MASLD in the context of the global obesity and type 2 diabetes epidemics, emphasizing that patients with type 2 diabetes are at the highest risk for progressive liver disease.

Viewers will learn how to confidently stage liver fibrosis using non-invasive tests (NITs) such as FIB-4, ELF, FibroScan, and MRI-PDFF, without relying on liver biopsies. The speaker outlines practical cutoffs to stratify risk, identify patients with advanced fibrosis (F2-F3), and decide when to refer for specialist care or initiate treatment. This presentation also explores how to monitor treatment response using these same tests over time.

Lifestyle modification remains a cornerstone of MASLD management, and the speaker breaks down evidence-based strategies—including the rule of 5% and 10% weight loss, the Mediterranean diet, time-restricted eating, and exercise routines that improve insulin sensitivity. For patients who require more than lifestyle change, the presentation walks through current options like GLP-1 receptor agonists and bariatric interventions.

A major highlight is the role of resmetirom (Rezdiffra), the first FDA-approved medication for MASH with moderate to advanced fibrosis. The speaker reviews data from the MAESTRO-NASH trial, explains how to start and monitor therapy, and shares practical tips for navigating side effects, statin interactions, and payer approval challenges. Also discussed are emerging therapies in the pipeline, including semaglutide, tirzepatide, and FGF21 agonists, as well as the anticipated future of combination therapy for treating liver fibrosis.

Whether you're a hepatologist, gastroenterologist, primary care provider, or endocrinologist, this lecture will equip you with up-to-date, actionable knowledge for identifying and treating high-risk patients with MASLD and MASH in clinical practice.

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