New studies, including two highly anticipated multidisciplinary meta-analyses, underscore the robust success of novel therapies in treating metabolic-associated steatotic liver disease (MASH). This condition is frequently referred to as a silent disease due to the absence of obvious symptoms. Gastroenterologists and hepatologists are rightfully alarmed by the growing epidemic of this condition. Their top peeve is its permissibility among patients with metabolic derangements, such as type 2 diabetes and obesity. The FDA has recently approved new medications to help fight MASH. This advance brings relief to the millions who suffer from this sometimes devastating disease.
MASH impacts an estimated 22 million American adults, and many don’t even know they are living with the disease. Damage to the liver can accumulate silently, Dr. Su, a gastroenterologist and hepatologist who practices at Michigan Medicine in Ann Arbor, cautions. This is usually the case when conditions are metabolic. “People often don’t know that liver damage can accrue with metabolic conditions like type 2 diabetes, obesity, insulin resistance, and high cholesterol,” he stated. Without basic knowledge, the cost of ignorance can be deadly. MASH can progress to liver cirrhosis, causing lasting scarring and possibly progressing to liver cancer.
Understanding MASH and Its Risks
MASH is marked by a dangerous accumulation of fat within the liver, which can result in life-threatening conditions. Normal livers are usually made up of visible layers or lobules of geometric units of rectangular-shaped liver cells. The build-up of fat disrupts this picture and operation. Alarmingly, up to a quarter of individuals diagnosed with MASH may go on to develop liver cirrhosis or liver cancer. These life-threatening diseases often result in organ abandonment.
Our community hero, Dr. James Hamilton, shines a light on the social stigma under which the condition suffers. “Folks don’t like it when you call them fatty,” he said, emphasizing what people experience when it comes to public conversations around weight-related health issues. Making MASH a serious issue. It has recently become the most common cause of liver transplants among women in the U.S.
In particular, the advancement of liver disease can be acute and drastic. Dr. Sanyal noted, “One of the scary things about liver disease is that for a very long time you have almost no symptoms… Then suddenly, all hell breaks loose, and everything starts going wrong.” This unpredictability serves to highlight the need for awareness and early intervention in managing MASH.
Recent Medical Advances
In March 2024, the FDA approved resmetirom for use in patients with MASH who show signs of liver scarring. Market under the brand name Rezdiffra, this medication worked miraculously in clinical trials. The residents participating in the study while on resmetirom showed groundbreaking results in their improvement. Notably, 37 percent of them experienced improvements in liver scarring, versus only 23 percent of patients on a placebo treatment.
Semaglutide, sold under the trade names Ozempic and Wegovy, is another new, very effective treatment with potential. It has gained notoriety for waging a successful campaign against the spread of type 2 diabetes and obesity, two critical risk factors for MASH. The recent STEP trials have shown that a 72-week course of semaglutide can lead to substantial weight loss in people with MASH. An incredible 63 percent of them had decreases in liver fat and inflammation compared with only 34 percent of the placebo group.
Tirzepatide is another contender already FDA-approved for diabetes and weight-loss. In addition to those medical purposes, experts think it can offer huge therapeutic advantages for people fighting MASH. Novo Nordisk has recognized the urgent need for treatment of MASH and is working to broaden the available options. In terms of next steps, they plan to request accelerated approval by US and EU drug regulatory agencies for semaglutide.
The Need for Awareness and Early Detection
Even with all this progress being made in treatment, the only hurdle is getting the word out about MASH and its severe effects that could be deadly. Since the disease is overlooked, many people do not know they are at risk as well. Or, they can be completely unaware of the threat until it’s too late. Furthermore, education regarding the symptoms and risk factors involved with these metabolic conditions is key to early detection.
Healthcare providers should be vigorously promoting routine prevention such as cancer screenings. This is critical, particularly for people with metabolic diseases, including obesity, diabetes, or hyperlipidemia. One thing that can make a huge difference is early diagnosis, which often allows these patients to avoid developing more serious liver complications.
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