Fatty liver disease happens when too much fat builds up in the liver. Metabolic dysfunction-associated steatohepatitis (MASH) is a severe type of fatty liver disease where fat buildup causes liver scarring and inflammation.
MASH is the new name for this condition. The old name was nonalcoholic steatohepatitis (NASH) because it does not result from alcohol use. Instead, MASH results from problems with how your body processes nutrients (metabolic dysfunction) and is associated with conditions such as obesity, type 2 diabetes, and high cholesterol.
Many people can manage MASH with healthy lifestyle changes. If it is not managed, MASH can lead to stiffening and scarring in the liver (fibrosis) and eventually progress to permanent liver damage (cirrhosis) or liver failure. MASH may not cause any symptoms, but doctors can do tests to check for inflammation and other signs of fatty liver disease.
If you have fatty liver disease, you may be considering treatment options. One medicine you might hear about is Wegovy (semaglutide). The FDA approved it for certain people with MASH in August 2025.
The FDA has also approved Wegovy for weight loss and reducing the risk of serious cardiovascular problems (such as heart attack and stroke) in certain people who have overweight or obesity, along with lifestyle changes. Wegovy may also be used for other conditions as determined by your health care provider.
This article focuses on common questions and answers about Wegovy for MASH.
Is Wegovy Right for My Fatty Liver Disease?
To see if Wegovy is right for you, your health care provider may consider factors like the type of fatty liver disease you have and how your liver looks on test results. They’ll also review your medical history to see if Wegovy is right for you.
More specifically, Wegovy is FDA-approved for adults with metabolic dysfunction-associated steatohepatitis (MASH) who have moderate to advanced liver scarring (fibrosis) but not severe, permanent liver damage (cirrhosis). Your doctor may refer to moderate liver scarring as fibrosis stage 2 (F2) and advanced liver scarring as fibrosis stage 3 (F3). To treat MASH, Wegovy is used along with a reduced-calorie diet and increased physical activity.
Wegovy contains the active ingredient semaglutide. Wegovy is not recommended for people who are already using other medicines that contain semaglutide or similar medicines.
How Does Wegovy Work for MASH?
Wegovy is a type of medicine called a GLP-1 receptor agonist. It acts like a natural hormone in the body that helps control appetite and food intake. By working on areas of the brain that regulate hunger, Wegovy can help people eat less and lose weight.
The exact way Wegovy works for MASH is not fully understood. Weight loss seems to be a key factor, along with other possible effects on liver inflammation and fat buildup.
How Was Wegovy Studied for MASH?
Wegovy is being studied in a large clinical study called ESSENCE. It is a randomized, double-blind, placebo-controlled study. That means people were randomly placed into groups to receive either Wegovy or a placebo (an injection with no active medicine), and no one knew which one they were using. Everyone in the study also received guidance on healthy lifestyle changes.
To study the effect of Wegovy on fatty liver disease, the clinical trial included 1,197 people with MASH and moderate to advanced liver scarring (fibrosis). To join the study, people needed to have a recent liver biopsy showing MASH with fibrosis stage 2 or 3 and a fatty liver disease activity score that met the threshold for a MASH diagnosis. People could not join if they already had permanent liver damage (cirrhosis). Other exclusions were heavy alcohol use, liver or kidney failure, inflamed pancreas, very high blood sugar, recent use of a GLP-1 receptor agonist, or recent dose changes of certain medicines.
The Wegovy study for MASH is being done in two parts. Part 1 looked at liver biopsy changes after 72 weeks of treatment. Part 2 is ongoing and is planned to continue for a total of 240 weeks (almost five years) to learn about long-term effects of Wegovy for fatty liver disease.
So far, the researchers have reported Part 1 results from the first 800 adults with MASH who completed 72 weeks of treatment. The following information describes the 800 people in this group, as of the time they joined the study:
- The median age was 57, with ages ranging from 49 to 65. The median refers to the middle value in a set of results.
- About 57% were female and the rest were male.
- Most participants (68%) were White, 27% were Asian, 0.6% were Black or African American, and the rest identified as other races or did not report race; 18% identified as Hispanic or Latino.
- Most people (69%) had advanced liver scarring (F3) and the rest had moderate liver scarring (F2).
- Most people were overweight or had obesity, with a median body mass index (BMI) of 34 and a body weight of about 93 kilograms (about 205 pounds). Some people (7%) had a BMI under 25, which is considered healthy.
- Many people had other weight-related health conditions including high blood pressure (63%), type 2 diabetes (56%), or high cholesterol (25%) and were taking standard medicines to manage them.
To measure changes in liver health, the participants had two liver biopsies: one before starting Wegovy or placebo and another at week 72. All biopsies were reviewed by at least two experts to check for improvement or worsening in liver scarring and other signs of fatty liver disease.
What Are the Main Benefits of Wegovy for MASH?
Part 1 of the study had two main goals (primary endpoints):
- To see how many people had resolution of MASH, meaning the signs of the disease went away, without their liver scarring (fibrosis) getting worse.
- To see how many people had improved fibrosis, meaning their liver scarring decreased by at least one stage, without their MASH getting worse.
To count as resolution of MASH, the liver biopsy at week 72 had to show no swelling of damaged liver cells (ballooning score of 0) and little to no inflammation (score of 0 or 1) on a standard scale used to check for fatty liver disease.
To count as an improvement in liver scarring, the liver biopsy at week 72 had to decrease by at least one stage on a standard fibrosis scale. This scale goes from stage 0 (no scarring) to stage 4, which is severe, permanent liver damage (cirrhosis).
The table below shows the percentages of people whose liver biopsy changes met the study’s primary endpoints at week 72:
Wegovy | Placebo | |
MASH resolved and no worsening of liver scarring | 63% | 34% |
Improved liver scarring and no worsening of MASH | 37% | 22% |
Overall, the results at 72 weeks show that Wegovy works better than a placebo to improve liver health, based on biopsy changes, in certain people with MASH. Studies are ongoing to learn about the long-term effects of Wegovy for MASH, including how long people go without developing more severe liver damage (cirrhosis-free survival).
Keep in mind that your results may differ from clinical studies.
How Do I Use Wegovy for MASH?
Wegovy is given as an injection under the skin. You or a caregiver, will be trained on how to give these injections at home. You can inject Wegovy into your abdomen, thigh, or upper arm. It is injected once weekly, typically on the same day of each week, at any time of day.
To help minimize common side effects such as nausea and other stomach issues, Wegovy treatment starts at a low dose and is slowly increased over several weeks. Here is a typical dosage schedule of Wegovy for MASH:
- Weeks 1-4: 0.25 mg once weekly
- Weeks 5-8: 0.5 mg once weekly
- Weeks 9-12: 1 mg once weekly
- Weeks 13-16: 1.7 mg once weekly
- Week 17 and on: 2.4 mg once weekly
For MASH, the recommended maintenance dosage of Wegovy is 2.4 mg once weekly. If this dose is hard to tolerate, your health care provider may lower it to 1.7 mg once weekly for a period of time, and then possibly increase it again later. Always follow your prescriber's exact directions.
How Can I Get Wegovy? Is There Any Cost Assistance Available?
Wegovy requires a prescription from a health care provider. You can fill your prescription at any pharmacy.
A cost assistance program is available from Novo Nordisk, the manufacturer of Wegovy. It may reduce the amount you pay. Whether you qualify to enroll may depend on what type of insurance you have or if you are uninsured. Visit this website from the drugmaker for more information about Wegovy costs and copay savings.
You can also contact the drugmaker at 833-493-4689 to connect with a representative for financial support information and other resources.
