A 44-year-old woman developed liver injury after starting semaglutide for weight management, with enzyme levels normalizing after discontinuation and worsening upon rechallenge, confirming the drug as the cause.
Positive rechallengeLiver injury resolved when semaglutide was stopped and returned when restarted — the strongest evidence of causation in a case report
What the researchers found
A 44-year-old woman developed drug-induced liver injury (DILI) after semaglutide initiation for weight management. The causal relationship was confirmed by a positive dechallenge-rechallenge pattern: liver enzymes normalized after discontinuation and elevated again when semaglutide was restarted.
The authors conducted a literature review of all reported semaglutide-related DILI cases, finding that hepatotoxicity from semaglutide, while exceedingly rare, is a documented adverse effect that warrants clinical awareness.
Why it matters
Semaglutide (Ozempic/Wegovy) is one of the most widely prescribed medications in the world, with millions of users for diabetes and weight management. While liver injury is rare, the enormous and rapidly growing user base means even uncommon side effects can affect many people. This case reinforces the importance of liver monitoring and raises awareness among prescribers.
How the study worked
Single patient case report with literature review. The case involved clinical documentation of liver enzyme changes correlated with semaglutide initiation, discontinuation, and rechallenge. The accompanying literature review surveyed all previously published cases of semaglutide-induced liver injury.
What this study cannot tell us
This is a single case report, the lowest level of clinical evidence. Individual case reports cannot establish incidence rates or risk factors. Other potential causes of liver injury may not have been completely excluded despite the positive rechallenge. The literature review scope and methodology are not detailed in the abstract.
How to read the evidence
This is a single case report with literature review — the lowest tier of clinical evidence, but the positive dechallenge-rechallenge pattern provides strong evidence of causation in this individual patient.
When this study was published
Published in 2025, this report is very timely given the explosive growth in semaglutide prescriptions for both diabetes and weight management.
The bigger picture
As GLP-1 receptor agonists become among the most prescribed drugs globally, post-marketing surveillance for rare adverse effects is critical. Most clinical trials are not large enough or long enough to detect very uncommon side effects. Case reports like this, while limited in scale, serve as early warning signals that help build the safety profile of these medications over time.
Questions still open
- What is the estimated incidence of semaglutide-induced liver injury across the millions of users worldwide?
- Are there specific patient risk factors — such as pre-existing liver conditions or concurrent medications — that increase susceptibility?
- Is the hepatotoxicity specific to semaglutide or could it occur with other GLP-1 receptor agonists?
Common questions
Should people on semaglutide be worried about liver damage?
What does 'positive rechallenge' mean and why is it significant?
Read the original research
Semaglutide-Induced Liver Injury.
ACG case reports journal, 12(8), e01776
Citation
Kalsi, Harsimran; Arora, Samneet Singh; Essilfie-Quaye, Kobina; Bassi, Raghav; Akhavan, Neeka; Perbtani, Yaseen; Brar, Tony S. (2025). Semaglutide-Induced Liver Injury.. ACG case reports journal, 12(8), e01776. https://doi.org/10.14309/crj.0000000000001776