New Names, New Drugs, Better Outcomes in Steatotic Liver Disease

Abstract

Steatotic liver disease (SLD) is a growing cause of chronic liver disease, with potential progression to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. Previously known as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), new terminology, including metabolic-dysfunction associated steatotic liver disease (MASLD) and metabolic-dysfunction associated steatohepatitis (MASH), was introduced to improve diagnostic clarity and reduce stigmatization. MASLD is now recognized as the hepatic manifestation of the metabolic syndrome and is the most common cause of liver disease in the UK, affecting up to 20% of adults. The incidence of MASLD-related cirrhosis and HCC is expected to rise significantly by 2030, highlighting the need for early diagnosis and treatment. For over two decades, effective medical therapies for MASLD were elusive. However, recent trials of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), thyroid hormone receptor-β (THR-β) agonist resmetirom, and fibroblast growth factor 21 (FGF21) agonists have shown promising results in reversing steatohepatitis and potentially fibrosis. These agents potentially offer new disease-modifying treatment options for MASLD, with GLP-1 RAs particularly effective in achieving weight loss and all drugs showing promising histological benefits in patients with MASH. This review summarizes nomenclature changes, provides an update on the UK's SLD burden, with a particular focus on MASLD and MASH, and discusses new therapeutic strategies for managing this complex and increasingly prevalent condition.

Keywords: GLP-1 RAs; MASH; MASLD; SLD; cirrhosis; hepatocellular carcinoma; metabolic and alcohol related/associated liver disease; nonalcoholic fatty liver disease.