A care pathway for resmetirom and semaglutide in MASH, and an early natriuresis signal with empagliflozin in refractory ascites

The edition in brief

An international expert panel in Gut has consolidated phase 3 data, FDA labels and early experience into a practical pathway for resmetirom and semaglutide, the two therapies with conditional FDA approval for MASH with F2–F3 fibrosis without cirrhosis, covering non-invasive diagnosis, choice by phenotype, patients already on GLP-1 receptor agonists, response assessment and when to switch or combine. In a 10-day open-label proof-of-concept trial of 21 patients with type 2 diabetes and refractory cirrhotic ascites, empagliflozin increased fractional sodium excretion and 24-hour urine sodium (by 92 mmol) and reduced paracentesis volume from 1.3 to 0.6 L a day, with no serious adverse events; this is far too small and short to change practice. In the ALSPAC birth cohort, maternal and paternal pre-pregnancy BMI were each associated with MASLD in offspring at 24, and biparental overweight with 3.7 times the odds, about two-thirds mediated by childhood BMI. A Cochrane review of six trials found very uncertain evidence on T-tubes in liver transplant biliary anastomosis. The FDA recorded a supplement to the adalimumab-aqvh biosimilar licence on 25 September; its content is not specified. The pearl covers FIB-4 triage in MASLD.