Over the past few years, glucagon-like peptide-1 (GLP-1) drugs like semaglutide (Ozempic, Rybelsus, Wegovy) have become a “go-to” medication. They’ve been part of breakthroughs in the treatment of conditions that range from overweight and obesity to type 2 diabetes to heart and kidney disease. These medications are now widely used to manage obesity and diabetes, and their potential for treating fatty liver disease is still being discovered.
GLP-1 drugs such as semaglutide (branded as Ozempic, Rybelsus, or Wegovy) were originally approved for type 2 diabetes but quickly gained popularity for weight loss. More recently, tirzepatide — a dual agonist sold as Mounjaro and Zepbound — has shown even greater weight loss benefits. These medications are now widely used to manage obesity and diabetes. But their potential for treating metabolic dysfunction-associated steatotic liver disease (MASLD) or its more advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is still being discovered.
These medications don’t just help you lose weight. They may also support your liver health in several important ways, including cutting down on liver fat, improving insulin sensitivity, lowering inflammation and scarring (fibrosis), and potentially reversing MASH or preventing it from advancing.
How Was MASH Treated Before GLP-1s?
Until recently, there were no FDA-approved treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) or its more advanced form, MASH. Doctors mainly suggest lifestyle changes, especially weight loss through diet and exercise. These are still a key part of treating and living with MASH, but many people need further support. Attention has turned to new therapies like GLP-1 drugs that could make a real difference.
“I think we’ll see a day soon when the majority of people who live with MASH are on a GLP-1 drug,” says Don Rockey, MD, a liver specialist and Chair of the Department of Medicine at the Medical University of South Carolina in Charleston, South Carolina.
How Do GLP-1 Agonist Drugs Affect MASH?
There are a couple of reasons why this group of medications can help treat MASH. One is that they help you lose weight.
“We know that weight loss can help to reverse MASH, and even fibrosis, or liver scarring that’s related to MASH,” says Adnan Said, MD, chief of the Division of Gastroenterology and Hepatology at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin.
Research bears this out. Studies show, for example, that if you lose just 5% of your body weight, you’ll cut your liver fat by 13%. If you lose about 10%, you can lower it by 52%, and if you shed 16% of your body weight, you’ll slash your liver fat by about two-thirds.
GLP-1 agonist drugs mimic GLP-1, a hormone that your body makes in your small intestine. These medications make you feel full faster, so that you don’t eat as much and you lose weight.
The drugs also work indirectly to reduce liver fat, since they improve your insulin sensitivity. When your body becomes less sensitive to insulin, it opens the door to a long list of health problems, including higher blood sugar levels. This, in turn, is a major cause of liver fat buildup.
“When you have insulin resistance, your body has to produce more of this hormone to make it effective, which causes fat to build up in your liver,” explains Said.
If you have type 2 diabetes, these drugs help with that as well. They also cause your pancreas to release more insulin, so you don’t see spikes in your blood sugar. This helps break a vicious cycle: Type 2 diabetes is a major risk factor for MASLD and MASH, and these conditions make it more likely that you’ll progress from prediabetes to type 2.
Almost two-thirds of people with MASH (about 63%) who took semaglutide for 18 months saw their condition resolve completely, according to a 2025 study. Another 37% had improvements in liver scarring, and their MASH didn’t get worse.
“The hope is that this will translate into the need for fewer liver transplants, as well as deaths from MASH complications,” says Robert Fontana, MD, a hepatologist at the University of Michigan Medical Center in Ann Arbor, Michigan.
To figure out if a GLP-1 for fatty liver is right for you, talk to your doctor about:
- Your BMI and related health conditions
- Any history of eating disorders
- What your insurance may or may not cover
- Other medications or health issues you’re managing
Resmetirom: Another Option for Treating MASH
Another drug, resmetirom (Rezdiffra), was approved by the FDA in March 2024 for patients with MASH. It is a thyroid hormone receptor agonist and works differently from GLP-1s.
“The medication targets thyroid hormone receptors in the liver that reduce the buildup of fat there,” explains Fontana. It improves liver fat, inflammation, and scarring.
According to a 2024 study, anywhere from 25% to 30% of people who take Rezdiffra see their MASH resolve after a year, depending on the dose. This compares to about 9% who take a placebo (inactive treatment). Another quarter saw an improvement in their fibrosis, or liver stiffness, and their MASH didn’t get worse.
“It may be a good option for people who don’t respond to just one of the medications, or who do respond but don’t see their MASH resolve completely,” says Said.
Combination Therapy: The Future of MASLD and MASH Treatment
Researchers have been studying the effects of combining these two medications with good results. While GLP-1s are the treatment of choice for the weight loss that is the foundation of MASLD and MASH treatment, resmetirom works better at treating fibrosis, especially for people who have a high level of scarring.
“It may be a good option for people who don’t respond to just one of the medications, or who do respond but don’t see their MASH resolve completely,” says Said.
We need more research to understand how well these medications work in the long term, but combining the two may soon become the standard treatment.
No Magic Bullets
Semaglutide, alone or in combination with resmetirom, may be a game changer for many people who live with MASH. But like any medication, it works best if you combine it with lifestyle measures such as eating a healthy diet and doing regular exercise.
“Both of these are very important to help keep your liver healthy and reverse MASH,” stresses Said.
A 2025 study shows that people with MASLD who lost weight, avoided alcohol, and exercised regularly were able to significantly improve their liver fibrosis, or scarring.
“We now have two very important drugs available to treat and even potentially reverse MASH,” says Fontana. “But you need to pair them with lifestyle to make sure you reap all of their benefits.”
