Advances in Semaglutide Therapy for Metabolic Liver Disease: A Closer Look at Dosage and Duration

Semaglutide pooled analyses show dose- and duration-dependent benefits for metabolic dysfunction-associated steatohepatitis (MASH) resolution.

In a meta-analysis of randomized trials, best outcomes clustered at a threshold of ≥2.0 mg weekly and treatment durations of ≥12 months. The analysis used histologic resolution of steatohepatitis and reductions in hepatic steatosis as primary endpoints.

Objective biomarkers improved: pooled estimates showed marked reductions in liver fat (~−11% MRI‑PDFF), clinically meaningful declines in ALT and AST, and substantial weight loss. These metabolic effects likely convey indirect cardiometabolic benefit and support routine monitoring of liver enzymes and noninvasive steatosis measures during therapy.

However, fibrosis regression was not meaningfully affected in the aggregated data; pooled analyses did not demonstrate consistent histologic fibrosis-stage improvement (no reliable ≥1‑stage fibrosis regression). Safety signals were dose-dependent and predominantly gastrointestinal.