Therapeutic approaches for different stages of MASLD

Effective treatmentImprove MASLImprove/resolution MASHImprove liver fibrosis/cirrhosis
-Diet and increased physical activity
-Bariatric surgery
-PPAR receptor agonists: pioglitazone, lanifribranor, saroglitazar
-Incretin receptor agonists: liraglutide, semaglutide, tirzepatide
-SGLT-2 inhibitors: dapagliflozin, empagliflozin
-Thyroid hormone receptor-β agonists: resmetirom
-Diet and increased physical activity
-Bariatric surgery
-PPAR receptor agonists
-Incretin receptor agonists
-SGLT-2 inhibitors
-Thyroid hormone receptor-β agonists
-Diet and increased physical activity
-Bariatric surgery
-PPAR receptor agonists
-Incretin receptor agonists
-Thyroid hormone receptor-β agonists
-Diet and increased physical activity
-Bariatric surgery
-PPAR receptor agonists
-Thyroid hormone receptor-β agonists

With the exception of resmetirom, drug treatments are currently considered off-label for MASLD. Some drugs are approved for treatment of MASLD-associated comorbidities such as type 2 diabetes and obesity. MASLD: metabolic dysfunction-associated steatotic liver disease; MASH: metabolic dysfunction-associated steatohepatitis; PPAR: peroxisome proliferator-activated receptors; SGLT-2: sodium-glucose cotransporter 2