Following regulatory approvals, the European liver, diabetes and obesity societies have issued joint guidance on resmetirom and semaglutide 2.4 mg as MASH-targeted therapy.
Pharmacotherapy is recommended for adults with non-cirrhotic MASH and fibrosis stage F2–F3, identified by non-invasive tests or biopsy, alongside structured lifestyle intervention and comorbidity management. Suggested non-invasive thresholds include transient elastography 10–20 kPa, MR elastography 3.1–5.0 kPa or ELF 9.8–11.3. Semaglutide may be preferred with obesity, type 2 diabetes or cardiovascular disease or risk; resmetirom where obesity is absent, or where GLP-1 agonists are already used or not tolerated. In MASH cirrhosis, both appear safe but should not be used as MASH-targeted treatment until liver benefits are shown.
The guidance also asks for nutritional and sarcopenia assessment on semaglutide and non-invasive tests to track response. Availability and cost of both agents in India differ from Europe.
- Stage fibrosis with non-invasive tests before considering MASH pharmacotherapy.
- Reserve drug treatment for non-cirrhotic MASH with F2–F3 fibrosis.
- Favour semaglutide when obesity, diabetes or cardiovascular risk coexist.
- Assess nutrition and muscle mass during semaglutide treatment.
- Do not start either drug as MASH-targeted therapy in cirrhosis.
Why it matters
It gives clinicians clear selection, monitoring and stopping rules as MASH drugs reach practice.
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