The edition · Gastroenterology & Hepatology
MASH has two licensed drugs and an expert framework for choosing between them
An international panel sets out how to pick, monitor and switch between resmetirom and semaglutide in F2-F3 fibrosis, individual patient data from eight trials put numbers on peg-interferon add-on in hepatitis B, and a synthesis of 8,993 patients quantifies what happens when a GLP-1 is stopped.
The edition in brief
Today's gastroenterology and hepatology edition opens with PROSPER, an individual participant data meta-analysis of eight trials in 581 patients with chronic hepatitis B on nucleos(t)ide analogue therapy who received peg-interferon add-on. Overall HBsAg loss was 8.6%, but stratified by baseline HBsAg it was 37.7% below 100 IU/mL, 9.8% at 100–1000 and 2.3% above 1000, consistent across Caucasian and Asian patients. An expert opinion in the Journal of Hepatology argues that hepatocellular carcinoma surveillance should be selected by expected benefit rather than by risk alone, reviewing abbreviated MRI protocols and blood biomarker panels. A meta-analysis of three studies covering 899,629 people found metabolic dysfunction-associated steatotic liver disease associated with a 35% higher odds of clinically diagnosed heart failure with preserved ejection fraction — an absolute increase of 0.35 percentage points. A synthesis of six trials in 8,993 patients found a 17.90% weight difference between those who stopped a GLP-1 receptor agonist and those who continued, with a larger rebound after tirzepatide than semaglutide. The edition closes on an international expert panel review covering the whole care pathway for resmetirom and semaglutide in MASH with F2-F3 fibrosis, from non-invasive diagnosis through response assessment and criteria for switching or combining.
Peg-interferon add-on clears HBsAg in 38% — but only if it was already below 100
Check quantitative HBsAg first — below 100 IU/mL peg-interferon add-on is a realistic route to clearance, above 1000 it is not.
HCC surveillance should be chosen by expected benefit, not by risk
Before intensifying surveillance, ask what you would do with an early diagnosis in this particular patient.
MASLD raises HFpEF odds by 35%, and the absolute difference is 0.35 percentage points
Treat the shared metabolic risk factors; this is not a reason to start screening MASLD patients for heart failure.
Stopping a GLP-1 costs most of the weight back, and more after tirzepatide
Tell patients before they start that stopping returns most of the weight, and treat any planned stop as a clinical decision with follow-up.
A normal ALT does not exclude significant fibrosis
Calculate FIB-4 on risk factors, not on liver enzymes — a normal ALT does not exclude advanced fibrosis.
How to actually use the two drugs now licensed for MASH fibrosis
Confirm F2-F3 fibrosis non-invasively, check what the patient is already taking, and agree what response will look like before you start.
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