Pharmacologic Treatments for MASLD: A Review of Efficacy and Safety Considerations.

Abstract

Objective: To summarize and compare current pharmacologic treatment options for metabolic dysfunction-associated steatotic liver disease (MASLD).

Data sources: PubMed was searched for English-language articles published from January 1, 2000, to May 1, 2026. Search terms included MASLD, metabolic dysfunction-associated steatohepatitis (MASH), nonalcoholic fatty liver disease, nonalcoholic steatohepatitis (NASH), pioglitazone, semaglutide, liraglutide, sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin, empagliflozin, treatment, and management.

Study selection and data extraction: Eighteen publications, including randomized controlled trials, review articles, and practice guidelines, were included in this narrative review article. These articles were included to evaluate the efficacy, safety, and accessibility of the treatment options.

Data synthesis: Five primary treatment options were reviewed: resmetirom, semaglutide, empagliflozin, dapagliflozin, and pioglitazone. Semaglutide and resmetirom demonstrated the most consistent evidence for MASH improvement including statistically significant improvement in fibrosis (reduction of at least 1 fibrosis stage). Pioglitazone showed improvement in several histologic features; however, findings for fibrosis improvement and placebo-adjusted benefit were inconsistent. Evidence for SGLT2 inhibitors remains promising but limited.

Conclusions: Semaglutide and resmetirom have the strongest evidence for histologic improvement in MASLD/MASH. Pioglitazone and SGLT2 inhibitors may offer benefits in patients with specific comorbidities, but additional research is needed.