Therapeutic potential of GLP-1 receptor agonists in MASH and liver fibrosis

Summaries 3 min 261

Font Size

Created On: 22/04/2026

Metabolic dysfunction-associated steatohepatitis (MASH), a gradually worsening liver ailment, is linked to fibrosis progression and cirrhosis risk.

See All

Key take away

GLP-1 receptor agonists improve liver disease activity and metabolic health in patients with at-risk MASH.

Background

Metabolic dysfunction-associated steatohepatitis (MASH), a gradually worsening liver ailment, is linked to fibrosis progression and cirrhosis risk. This meta-analysis explored the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in high-risk MASH.

Method

An extensive assessment of randomized controlled trials (RCTs) was executed using data from PubMed, Embase, and Cochrane databases. Primary endpoints were MASH resolution without fibrosis worsening and fibrosis betterment without MASH advancement. Secondary endpoints were adverse events, biochemical markers, and metabolic parameters.

Studies involving dual incretin agonists (GLP-1 with glucagon or Glucose-dependent insulinotropic polypeptide) were also included. Meta-regression was performed to determine the influence of weight loss and glycemic control on histological outcomes.

Result

A total of 7 RCTs (n=1,800; mean follow-up ~136.8 weeks) were analyzed. In patients with F2–F3 fibrosis, the following improvements were noted:

MASH resolution without fibrosis worsening:
Risk ratio: 2.96 (95% confidence interval: 1.70–5.15)
Fibrosis improvement without MASH worsening:
Risk ratio: 1.59 (95% confidence interval: 1.32–1.90)

Additional benefits included improvements in liver enzymes (aminotransferases), magnetic resonance imaging-proton density fat fraction (MRI-PDFF), glycemic control (hemoglobin A1c [HbA1c]), lipid profile and blood pressure, and body weight and anthropometric measures. While gastrointestinal side effects were more frequent, serious adverse events were not increased when compared to placebo.

Conclusion

GLP-1 RAs demonstrated remarkable benefits in resolving MASH and improving liver fibrosis, alongside enhancing cardiometabolic health. These findings position GLP-1 RAs as promising disease-modifying therapies for those with at-risk MASH. Ongoing trials will clarify their impact on long-term clinical outcomes, including mortality and liver-related complications.