Two New Drugs for Fatty Liver, and the Scan That Decides Who Gets Which
✓Medically Reviewed by Dr. Şekip Altunkan on Oct 27, 2026.
Key Takeaway
A joint clinical practice guideline from three European medical societies now recommends resmetirom and semaglutide for non-cirrhotic MASH patients with stage 2 to 3 fibrosis defined by elastography or blood-based biomarkers rather than liver biopsy. The choice of agent is dictated by the patient’s cardiometabolic profile, and neither drug is recommended as a liver-targeted therapy once cirrhosis is established.
Liver Stiffness That Obviates Biopsy
A 54-year-old woman with type 2 diabetes presents with a body mass index of 34 kg/m² and persistently borderline-elevated ALT levels spanning several years. Flagged last spring with an elevated FIB-4 score, her transient elastography evaluation today reveals a liver stiffness measurement of 13.2 kPa. A decade ago, the definitive next step would have entailed an intercostal core needle biopsy, an anxious wait for histopathology, and procedural risks. Today, that invasive pathway is no longer mandatory.
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 38% of adults globally[2]. The vast majority will never develop cirrhosis. The core clinical imperative is identifying the vulnerable minority whose fibrosis is quietly progressing toward end-stage liver disease—and intervening before decompensation occurs. With two approved pharmacological agents and validated non-invasive stiffness thresholds, clinicians can finally accomplish this proactively.
The Guidance
This publication is not an empirical randomized trial; rather, it is a unified clinical practice guideline issued jointly by the European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD), and the European Association for the Study of Obesity (EASO) following the regulatory approvals of both agents. It builds upon the societies’ 2024 MASLD guidelines, which established a stepped case-finding algorithm utilizing FIB-4 followed by elastography[3].
The guidance evaluates two pharmacotherapies: oral resmetirom at 80 mg or 100 mg daily, and subcutaneous semaglutide at 2.4…
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Medically reviewed by
Dr. Şekip Altunkan
Dr. Şekip Altunkan is an internal medicine specialist with extensive clinical experience. He trained at Hacettepe University Faculty of Medicine and later served as an Associate Professor in Internal Medicine. He founded and led the Metropol Internal Medicine and Hypertension Clinic in Ankara, pioneering non-invasive Electron Beam Tomography (EBT) cardiac imaging, arterial-stiffness measurement, and nationwide Holter monitoring. He currently practices at his private clinic in Ankara, focusing on hypertension, vascular health, cholesterol, diabetes and heart disease. He has published widely in national and international journals, serves as a peer reviewer for several international journals, and is the author of the book "Questions and Answers on Hypertension."
