The Latest in MASH Treatments: What’s on the Horizon

Written by Deanna Altomara
Medically Reviewed by Melinda Ratini, MS, DO on September 25, 2025
9 min read

When you have metabolic dysfunction-associated steatohepatitis (MASH), time is of the essence for treatment. Untreated, it can lead to cirrhosis and liver failure. 

Medication will be an important part of your treatment plan for MASH (formerly called nonalcoholic steatohepatitis). Right now, there are only two drugs approved by the FDA for MASH: resmetirom and semaglutide.

But there may be more options soon. Doctors are studying whether other drugs can help with MASH. Some of these drugs are already used for other conditions such as obesity or diabetes. Others are brand new.

You’ll need to partner with your doctor to learn which of these drugs may be right for you. Grace Su, MD, FAASLD, President of the American Association for the Study of Liver Diseases, explains, “Each person is different. Not everyone responds to one particular medication, so decisions about which one to use and when should be personalized depending on the person’s medical history and comorbidities (other conditions).”

Here are a few of the latest and upcoming treatments for MASH:

Resmetirom is approved by the FDA for moderate to advanced liver scarring (fibrosis) caused by MASH. It can slow down or reverse that scarring.

What does resmetirom do?

Resmetirom tweaks the way your body absorbs a certain thyroid hormone. This change helps keep fat from building up in your liver, which leads to less inflammation and scarring.

How is resmetirom different from other MASH treatments?

Most other MASH treatments are GLP-1 drugs, which means they affect a different type of hormone. 

How is resmetirom taken?

You take an 80-100 mg pill once a day. To see the best results, you also should follow a healthy diet and exercise.

Where is resmetirom in the research pipeline?

The FDA has approved resmetirom for the treatment of MASH with stages II and III fibrosis. This means your doctor can write you a prescription for it if it’s the right treatment for you. 

Resmetirom study results

Doctors gave almost 900 people with moderate to advanced fibrosis either 80 mg or 100 mg of resmetirom or a placebo (an inactive treatment). One year later, the people who took the drug were more likely to have no additional scarring or a reversal of scarring. About 1 in 4 people who took resmetirom saw their scars improve.

What’s next?

If you’re interested in trying resmetirom, talk to your doctor.

You may have heard of semaglutide. It’s famous as a weight loss drug. But Wegovy, a brand of injectable semaglutide, has now been improved to treat MASH. 

What does semaglutide do?

Semaglutide is a GLP-1 agonist. It fights inflammation and prevents the buildup of fat in the liver.

How is semaglutide different from other MASH treatments?

Semaglutide is related to liraglutide and tirzepatide, which are other GLP-1 agonists. But semaglutide (Wegovy) is the only one to be FDA-approved for MASH with moderate to advanced fibrosis.

How is semaglutide (Wegovy) taken?

You take it as a shot you give yourself once a week.

Where is semaglutide in the research pipeline?

Semaglutide (Wegovy) is currently in a phase III trial. But the results are so promising that the FDA recently approved it to treat MASH.

Semaglutide (Wegovy) study results

In the latest study (the first part of the current phase III trial), 800 people with MASH got a weekly shot with semaglutide (Wegovy) or a placebo. After six months, people who got the semaglutide shot were more likely to have seen improvements. 

In total, about two-thirds of people on the semaglutide shot saw their MASH get better with no additional scarring. About one-third didn’t see their MASH get better, but they did have improvements in scarring.

What’s next?

The current phase III trial will continue for another four years. This will help doctors see how the drug works over time. Meanwhile, you can ask your doctor if semaglutide (Wegovy) could help with your MASH.

Liraglutide is a GLP-1 agonist. It’s mainly used to treat type 2 diabetes. It may also help with MASH, although the FDA hasn’t approved it for this purpose. Your doctor may choose to prescribe it off label.

What does liraglutide do?

Liraglutide lowers inflammation and prevents the buildup of fat in the liver. It also helps with weight loss and cardiovascular health.

How is liraglutide different from other MASH treatments?

This drug is a GLP-1 agonist, so it’s closely related to other GLP-1 agonists such as semaglutide and tirzepatide.

How is liraglutide taken?

You take it as a daily shot in the upper leg, stomach, or upper arm, which you can give yourself.

Where is liraglutide in the research pipeline?

It has finished a phase II clinical trial. Right now, it’s available for diabetes but isn’t approved for MASH.

Liraglutide study results

Doctors gave 26 people with MASH a daily shot with liraglutide and 26 a shot without it. After four months, the people who had the liraglutide shot were more likely to see their condition improve.

What’s next?

Doctors need to do larger studies to get a better idea of how liraglutide affects MASH.

This is a GLP-1 agonist like liraglutide and semaglutide.

What does tirzepatide do?

Like other GLP-1 agonists, tirzepatide fights inflammation and keeps fat from building up in the liver.

How is tirzepatide different from other MASH treatments?

Tirzepatide is a GLP-1 agonist, so it’s related to liraglutide and semaglutide. But it’s better for weight loss than its cousins.

How is tirzepatide taken?

You take it yourself as a weekly shot.

Where is tirzepatide in the research pipeline?

It’s currently in a phase II clinical trial. 

Tirzepatide study results

For the phase II clinical trial, doctors gave 190 people with MASH a weekly shot with or without tirzepatide. One year later, the people who had the tirzepatide shot were more likely to have improvements. Up to 62% saw their MASH get better with no additional scarring, and half saw their scarring improve with no worsening of MASH.

What’s next?

Planning for the phase III clinical trial is underway. Doctors will be looking for 4,500 people to participate in the study.

This drug class works by activating a nuclear receptor in the body called the farnesoid X receptor. It’s a group of drugs that includes cilofexor, obeticholic acid, tropifexor, and vonafexor. 

What do FXR agents do?

Everything that happens in your body is controlled by your genes. Each gene has an “on” and “off” switch. FXR agents work by pressing the “on” button — the farnesoid X receptor — for certain genes that control bile production and the metabolism of blood sugar and blood fats. They also play a role in liver inflammation and scarring. Turning these genes on may help prevent or reverse the scarring and fibrosis seen in MASH.

How are FXR agents different from other MASH treatments?

Most other MASH treatments work by influencing your body’s hormones. FXR agents turn on certain genes instead.

Where are FXR agents in the research pipeline?

A phase III clinical trial for obeticholic acid, the most promising FXR agent, was ended early. The company had applied for FDA approval and was denied. 

Other FXR agents have finished phase II clinical trials.

FXR agents study results

A summary of studies on obeticholic acid showed that it improved MASH and scarring. But it also raised cholesterol levels and sometimes caused extreme itchiness.

A phase II study found that taking a combination of cilofexor and firsocostat for four months improved MASH and may help with scarring.

What’s next?

Doctors need to study these drugs in more phase III clinical trials.

Originally a diabetes drug, pioglitazone raises insulin sensitivity. Some studies suggest it might also help with MASH.

What does pioglitazone do?

It also clears up inflammation and prevents the buildup of fat in the liver.

How is pioglitazone different from other MASH treatments?

Most other MASH treatments are GLP-1 agonists, but this one is a PPAR-γ agonist. That means it works on a different chemical in the body.

How is pioglitazone taken?

You take 30-45 mg per day as a tablet.

Where is pioglitazone in the research pipeline?

Pioglitazone has been studied in phase III and IV clinical trials, but it hasn’t been approved by the FDA to treat MASH.

Pioglitazone study results

The evidence is mixed. In one study, doctors gave 247 people with MASH and without diabetes a daily pill with either pioglitazone, vitamin E, or a placebo. After 22 months, people who took pioglitazone did not have improvements in their MASH.

But other studies have shown the pioglitazone fights MASH and calms down inflammation. It also may help a little bit with liver scarring. It may be especially effective for people with type 2 diabetes.

What’s next?

We need more research to know for sure how effective this medication is. Doctors are looking for people with type 2 diabetes and MASH to participate in a phase II clinical trial.

This vitamin is a type of antioxidant. It destroys free radicals, which are chemicals that can lead to cancer and other diseases.

What does vitamin E do?

It gets rid of harmful free radicals, which can lead to inflammation.

How is vitamin E different from other MASH treatments?

Vitamin E is an antioxidant you can buy over the counter.

How is vitamin E taken?

You can take it as a daily tablet.

Where is vitamin E in the research pipeline?

Vitamin E has been in a couple of major studies, but it hasn’t been approved by the FDA to treat MASH.

Vitamin E study results

In a phase III study, doctors gave people a pill with pioglitazone, vitamin E, or a placebo. Almost two years later, about 43% of people who took vitamin E had improvements in MASH but not scarring.

What’s next?

Doctors want to study the long-term effects of vitamin E, as some fear it could increase the risk of prostate cancer and stroke. It is not recommended for people with diabetes or advanced cirrhosis.

If you’re interested in trying a new medication for MASH, talk with your doctor. They can help you choose the best drug for you. If that drug is still being researched, they can help you join a clinical trial that you may qualify for. You can also find a list of clinical trials at clinicaltrials.gov. 

If you find a study that looks like a good fit, you can meet with someone from the research team to find out more and confirm that you meet the enrollment criteria. You’ll need to sign a consent form. You may get a treatment that’s not yet available to the public, and any travel expenses may be paid. There are strict guidelines in place to make sure that your treatment as part of the study is safe. You can stop your involvement at any time for any reason. Taking part in a study is a way to not only be actively involved in your care but also to potentially help find a medication that will help others with the same condition.

Su adds that it’s important to remember the basics: diet and exercise. “One thing to keep in mind is that while we are so excited about finally having effective therapy for the treatment of MASH, lifestyle modifications like diet and exercise remain very important,” she says.

Advances in medications have made the treatment of MASH more effective than ever before. But lifestyle changes are key: The main ways to treat MASH are still a healthy diet and exercise. This includes actions such as eating the Mediterranean diet, doing cardiovascular exercises such as jogging and swimming, and avoiding alcohol. 

If you have obesity and advanced liver disease, bariatric (weight loss) surgery may be an option. This kind of surgery will not only help you lose weight but also can help improve or reverse liver damage. It also lowers your chances of cirrhosis, liver cancer, and needing a liver transplant.