Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterised by the accumulation of fat in the liver and is closely associated with metabolic conditions such as obesity and type 2 diabetes. In its most advanced form, known as metabolic dysfunction-associated steatohepatitis (MASH), it can lead to liver fibrosis and increase the risk of serious complications, such as cirrhosis and liver cancer.

Recently, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have approved the use of resmetirom and semaglutide for the treatment of MASH without cirrhosis and with moderate to high degrees of fibrosis, alongside lifestyle-related measures and the management of other metabolic conditions.

With the aim of incorporating these therapies into clinical practice, Dr Andreea Ciudin, coordinator of the Comprehensive Obesity Treatment Unit at Vall d’Hebron University Hospital and principal investigator of the Diabetes and Metabolism research group at the Vall d’Hebron Research Institute (VHIR), has contributed to the development of a European clinical guideline on the use of resmetirom and semaglutide in people with MASH. The document, published in the Journal of Hepatology, was developed by members of the European Association for the Study of the Liver (EASL), the European Association for the Study of Obesity (EASO) and the European Association for the Study of Diabetes (EASD).

The guideline provides recommendations for healthcare professionals on selecting people who are candidates for treatment with resmetirom or semaglutide, choosing the most appropriate treatment based on each patient’s characteristics, implementing and integrating the therapies, and providing long-term follow-up.

“The guideline highlights that treatments should be individualised according to each person’s risks and characteristics, including the presence of obesity, type 2 diabetes and other cardiovascular, renal or metabolic conditions”, explains Dr. Ciudin, who participated as co-chair of the European Association for the Study of Obesity (EASO) Obesity Management Working Group. In this regard, semaglutide is particularly recommended for people with MASH who have obesity, type 2 diabetes or cardiovascular conditions because of its cardiometabolic benefits. By contrast, resmetirom is prioritised for people without obesity or for those who do not tolerate semaglutide.

The guideline also includes recommendations for monitoring the safety and efficacy of the treatments. Among other aspects, it highlights the importance of monitoring nutritional status and ensuring the maintenance of muscle mass during treatment.

The guideline was developed based on an analysis of the available scientific literature and with the participation of healthcare professionals, patient representatives and other professionals working in the field of MASH.