Treatment Options for MASH

Metabolic dysfunction-associated steatohepatitis (MASH) is an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD). In people with MASH, fat buildup in the liver leads to inflammation and liver cell damage. If left untreated, MASH can cause serious liver problems. It can lead to cirrhosis of the liver, liver failure, and liver cancer.¹

Unfortunately, there is no cure for MASH. But with early detection and the right treatment plan, it can be managed.²

What are the goals of MASH treatment?

The ultimate goals of treating metabolic dysfunction-associated steatohepatitis are to:²

• Prevent the disease from getting worse
• Reduce liver inflammation and damage
• Improve overall liver health and quality of life
• Prevent complications

How is MASH treated?

Just as there are multiple stages of MASH, there are several stages of treatment. Depending on how advanced a person’s MASH is, the following treatments may be recommended:^2-8

• Weight loss through lifestyle changes like diet and exercise
• Controlling other health conditions you may have, like type 2 diabetes and cardiovascular disease (CVD)
• Medicines to treat liver fibrosis
• Liver transplant, for severe cases in which a person has end-stage liver failure

Lifestyle changes

One of the pillars of managing MASH is adopting a healthy lifestyle. This begins with making mindful choices about what you eat and adding regular physical activity into your routine.^2,3

Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help reduce liver fat and inflammation. Limiting excessive carbohydrates, processed foods, sugary beverages, and saturated fats is also important.^2,3,8

Aim to get at least 30 minutes of moderate-intensity exercise most days of the week. Low-impact activities like brisk walking, cycling, or swimming can be great for many people. Regular exercise helps improve liver health, control weight, and reduce the risk of complications linked to MASH.^2,3

Managing comorbidities

Many people with MASH have comorbidities such as obesity, type 2 diabetes, and CVD. Managing these health conditions is important because they can worsen liver damage and increase the risk of complications.^2,3,7,8

Treating overweight and obesity

Losing weight is the recommended first-line treatment for people with obesity and MASLD or MASH. Losing 5 to 10 percent of your body weight can have a significant impact by helping:^2,8

• Reduce the amount of fat that builds up in your liver
• Reduce inflammation throughout your body
• Improve how your body processes blood sugar

Managing type 2 diabetes

Type 2 diabetes and MASLD often coexist. If you have type 2 diabetes, you will need to make sure you are managing it well. Talk to your doctor about which treatment is right for you.^2,7

The following medicines may be used to help treat type 2 diabetes and MASLD:^7,8

• Metformin – This is a diabetes medicine that regulates blood sugar. It has been shown to have a positive effect on liver health.
• Pioglitazone – This drug can help reduce fibrosis in people with MASH and prediabetes or type 2 diabetes.
• Glucagon-like peptide 1 (GLP-1) receptor agonists – GLP-1 drugs such as semaglutide, liraglutide, and tirzepatide are proven to be useful in the treatment of both diabetes and MASH. Several of them have also been shown to be useful in inducing weight loss.
• Sodium-glucose co-transporter type-2 (SGLT-2) inhibitors – SGLT-2 drugs such as empagliflozin and dapagliflozin help improve glucose control. They are increasingly being considered for MASLD and MASH treatment, whether or not the person has diabetes.

Managing cardiovascular disease

CVD is the leading cause of death among people with MASH and MASLD. The most common types of CVD in those with MASH are high cholesterol and high blood pressure.^2,3

Doctors may prescribe a statin medicine for those with high cholesterol. Statins work by blocking an enzyme that contributes to the production of cholesterol in the body.⁹

For those with high blood pressure, doctors may prescribe the following:^1,2,10

• Angiotensin-converting enzyme (ACE) inhibitors – These drugs reduce blood pressure by blocking hormones that can tighten blood vessels. They have been shown to reduce fibrosis.
• Angiotensin receptor blockers (ARBs) – These drugs lower blood pressure by widening blood vessels.
• Beta-blockers – These drugs block adrenaline, a hormone that causes your heart rate and blood pressure to rise.

Medicines to treat liver fibrosis (liver scar)

To date, there is one drug approved to treat MASH in patients with liver fibrosis (scar in the liver). This drug is called Rezdiffra™ (resmetirom). It has been approved by the US Food and Drug Administration (FDA) to treat people with MASH who have moderate to severe liver scarring.⁵

Rezdiffra may interact with other medicines, particularly statins. Talk to your doctor about whether this drug is right for you. Before beginning treatment for liver fibrosis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.⁵

Liver transplant for advanced cases

In severe cases in which MASH has led to cirrhosis or liver failure, a liver transplant may be necessary. During a liver transplant, a damaged liver is replaced with a healthy liver from a donor. While this is a major surgical procedure with risks, it can be a life-saving option for those with advanced MASH.⁶

Can MASH be prevented?

Preventing MASH begins with adopting a healthy lifestyle early on. Here are some preventive methods to consider:^2-4

• Adopt healthy eating habits – Focus on whole foods, limit processed foods and added sugars, and watch portion sizes.
• Get regular exercise – Incorporate regular physical activity into your routine to help maintain a healthy weight.
• Monitor your health – Get regular checkups from your healthcare provider to monitor for signs of liver disease or related conditions.
• Avoid alcohol – While MASH is not caused by alcohol consumption, excessive drinking can contribute to liver damage.
• Manage comorbidities – Control conditions like diabetes, high cholesterol, and obesity through medicine, diet, and lifestyle changes.

Early detection is essential for disease management

If caught early enough, MASH can be managed and liver damage can be stopped in its tracks. By making healthy lifestyle choices, treating comorbidities, and seeking appropriate medical care, people with MASH can improve their liver health and overall quality of life. Remember, prevention is key. Be proactive in protecting your liver and well-being.¹