Tirzepatide in Metabolically Dysfunctional-Associated Steatohepatitis (MASH): A Bibliometric and Evidence-Based Review.

Abstract

Purpose: Metabolically-dysfunction-associated steatohepatitis (MASH) is the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) and is strongly linked to obesity and type 2 diabetes mellitus (T2D). Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist, has emerged as a promising therapeutic option due to its profound metabolic effects and potential hepatic benefits. This study integrates bibliometric mapping with current clinical evidence to evaluate tirzepatide's role in MASLD/MASH.

Methods: A bibliometric search was conducted in the Web of Science Core Collection (2018-2025) using predefined keywords related to tirzepatide and metabolic liver disease. Twenty-five full-text publications-including randomized controlled trials, post hoc analyses, meta-analyses, mechanistic reviews, and international guidelines-were systematically reviewed. Co-occurrence networks were generated using VOSviewer.

Results: Scientific output on tirzepatide and MASLD/MASH has increased rapidly since 2020, with thematic clusters centered on metabolic regulation, hepatic inflammation, and fibrosis. Clinical evidence shows that tirzepatide induces substantial weight loss, improves glycaemic control, and reduces hepatic biomarkers such as ALT, AST, K 18, and Pro C3. The SYNERGY-nonalcoholic steatohepatitis (NASH) trial demonstrated high rates of MASH resolution without fibrosis worsening and meaningful fibrosis regression at 52 weeks. Network meta-analyses position tirzepatide among the most effective therapies currently available. Recent EASL-EASD-EASO guidelines recommend tirzepatide for MASLD patients with obesity, T2D, or cardiometabolic risk.

Conclusions: Tirzepatide combines potent metabolic effects with significant hepatic improvements, positioning it as a promising therapy for MASLD/MASH. Although long-term and phase III data are still needed, current evidence supports tirzepatide as a key component of modern metabolic liver disease management.