Emerging Therapies and Real-World Application of Metabolic Dysfunction-Associated Steatotic Liver Disease Treatment

Kim, Hee Yeon; Rinella, Mary E.

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Clin Mol Hepatol > Accepted Articles

Review

Emerging Therapies and Real-World Application of Metabolic Dysfunction-Associated Steatotic Liver Disease Treatment

Hee Yeon Kim¹, Mary E. Rinella²

¹Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
²University of Chicago, Pritzker School of Medicine, Chicago, IL, USA

Correspondence :

Mary E. Rinella ,
Email: mrinella@bsd.uchicago.edu

Received: January 22, 2025 Revised: March 13, 2025 Accepted: March 30, 2025

ABSTRACT

Metabolic dysfunction-associated steatotic liver disease, formerly referred to as non-alcoholic fatty liver disease, is the most common liver disease in Western countries and has emerged as the leading indication for liver transplantation. Metabolic dysfunction-associated steatohepatitis (MASH), a more advanced stage, carries a high risk of progression to liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Until recently, lifestyle intervention remained the mainstay of MASH management, with no pharmacological treatments specifically approved. However, advances in understanding its pathophysiological mechanisms have fueled numerous clinical trials, culminating in the FDA's approval of resmetirom as the first treatment for MASH in 2024. Additionally, many investigational drugs are nearing FDA approval or progressing through late-stage clinical trials. This review examines the current therapeutic landscape, highlights strategies for identifying patients suitable for liver-directed therapies in real-world settings, and discusses the challenges that remain.

KeyWords: Clinical trials; Metabolic dysfunction-associated steatotic liver disease; Pharmacological treatments; Steatohepatitis