Obesity Science Fuels a Race for Advances in MASH Therapy
A dramatic race is progressing quietly and out of view for most of us. It is the race toward better therapy for the liver disease doctors know as MASH (metabolic associated steatohepatitis), which has close ties to obesity. And likewise because of advances in obesity science, progress in treating MASH is advancing with blinding speed that will sneak up on most of the world.
Clinical scientists are quickly figuring out that better therapies for obesity can yield better therapy for MASH. Of course advances with GLP-1 agonists are part of this story. But equally important is the role of metabolic and bariatric surgery.
Making the Link
In a new editorial for Clinical Gastroenterology and Hepatology, Niharika Samala and Mohammad Al-Haddad explain that the critical link between obesity and MASH therapies came from two recent studies:
“Studies by Abad et al and Lassailly et al underscore the importance of weight loss, whether achieved through endoscopic, surgical, or even lifestyle or pharmacologic means in the treatment of MASH.
“As the field continues to evolve, a multimodal approach that combines these interventions [surgery, lifestyle, and medicines] may offer the best chance for improving outcomes in patients with MASH.”
The Abad study showed that losing 10% or more of body weight could triple the odds of disease resolution for MASH patients. The Lassailly study delivered important and long-sought evidence that a histologic surrogate endpoint (i.e. MASH resolutions without worsening fibrosis) is predictive of an important clinical outcome like mortality. Both of these studies were studies of metabolic and bariatric surgery.
Learning from Advanced Obesity Medicines
In Nature Reviews Gastroenterology & Hepatology, Herbert Tilg and Giovanni Targher summarize the progress that semaglutide, tirzepatide, and a range of new obesity medicines promise for MASH treatment. They explain that these medicines have done much to improve the understanding of MASH:
“In summary, the efficacy of GLP-1s in MASH and fibrosis suggests more than ever that this disease should be considered a systemic metabolic disorder in which liver disease is a component of the syndrome. ”
Big studies on new therapies such as survodutide will bring important news and, potentially, important advances to therapy for MASH. This is a disease with a global health burden that is large and growing. So the progress is much needed.
Click here for the review by Tilg and Targher. For the editorial by Samala and Al-Haddad, click here.
Liver Segment Classification by Couinaud, illustration from the Database Center for Life Science and Anatomography BodyParts3D, licensed under CC BY-SA 2.1 JP
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July 1, 2025
