Metabolic dysfunction-associated steatohepatitis (MASH) is the progressive, inflammatory form of metabolic dysfunction-associated steatotic liver disease (MASLD) and one of the most rapidly growing causes of end-stage liver disease in the United States. An estimated 14.9 million Americans had MASH in 2020; that figure is projected to reach 23.2 million by 2050. Despite this burden, real-world clinical records capture MASH prevalence at only 0.15% of adults, indicating the vast majority of patients remain unidentified and untreated. The MASH therapeutic landscape has transformed substantially with two FDA approvals in 18 months: resmetirom and semaglutide 2.4 mg/week, both indicated for non-cirrhotic MASH with significant fibrosis. Agent selection requires an understanding of their distinct mechanisms, metabolic effects, comorbidity considerations, monitoring requirements and tolerability differences. Additionally, the non-invasive testing (NIT) frameworks that determine which patients qualify for treatment have been substantially updated by AASLD’s 2025 practice guidelines on blood-based and imaging-based assessment — replacing earlier guidance and requiring integration into clinical workflow. For patients with compensated MASH cirrhosis the fibroblast growth factor 21 (FGF21) analog class represents the most clinically advanced area of investigational research, with ongoing Phase 3 programs in both pre-cirrhotic MASH and compensated cirrhosis. This program is specifically designed for the liver/GI specialty audience: hepatologists, gastroenterologists, and advanced practice providers who manage patients with MASH and are positioned to implement the updated NIT framework, initiate approved pharmacotherapy, and counsel patients on emerging options.
Upon completion of this activity, participants should be able to: