VIDEO: GLP-1 use for MASH is ‘not black and white’; best approach may lie in the gray
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In a Healio video exclusive, Edward V. Loftus Jr., MD, noted that, despite the boom in glucagon-like peptide-1 agonists for diabetes and weight loss, its role in the treatment of liver disease is still up for debate.
“These drugs obviously have taken off, being used to treat patients who are obese or have diabetes, but it’s not clear if they affect fibrosis,” Loftus said. “Now that we have a drug on the market – resmetirom or Rezdiffra – specifically for metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated steatohepatitis, should we be using that?”
Physicians managing liver disease have voiced concerns on the fallout from the GLP-1 explosion, specifically its impact on MASH drug development, as patients who have initiated GLP-1 therapies are often subsequently ineligible for clinical trials of dedicated MASH drugs. Yet, this begs the larger question: With the advent of GLP-based therapies, do we even need to develop drugs for MASH?
In this month’s Healio Gastroenterology Exclusive, two hepatologists — Rohit Loomba, MD, MHSc, and Arul Sanyal, MD — square off with two endocrinologists — Rita Basu, MD, and Scott Isaacs, MD, FACP, FACE — to offer their unique insights on how each specialty can best leverage the benefits of GLP-1s for the treatment of MASH.
“The burden of MASLD is increasing globally, leading to significant mortality, morbidity and cost,” Zobair M. Younossi, MD, MPH, wrote in an accompanying editorial. “Given the close association of MASLD with obesity and type 2 diabetes, managing these comorbidities — initially though lifestyle intervention and supplemented by anti-obesity and antidiabetes regimens such as GLP-1s — will be important.”
Loftus echoed these sentiments, emphasizing that combining efforts and medications offers the best possible outcome for patients.
“There are a lot of different points of view on this matter,” Loftus said. “I think, as in most debates, it’s not black and white. There is probably a role for both GLP-1 agonists as well as medications that specifically treat MASLD or MASH.”
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