Fatty Liver Disease Treatment Is Changing Fast — And GLP-1 Drugs Are Leading the Charge | Research

The takeaway

GLP-1 receptor agonists and multi-agonist peptides are among the most promising treatments for MASLD/MASH, the world's most common liver disease that currently affects up to 30% of adults.

~30% of adults affected
MASLD (fatty liver disease) affects roughly a quarter to a third of the global adult population, with peptide-based drugs now emerging as the first pharmacological treatment options

What the researchers found

The treatment landscape for metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) and its inflammatory progression to MASH (formerly NASH) is rapidly evolving, with peptide-based drugs playing a central role. GLP-1 receptor agonists, GLP-1/GIP dual agonists, and GIP/GLP-1/glucagon triple agonists are all being investigated as treatments that could halt or reverse liver disease progression.

These peptide therapies join other emerging drug classes including thyroid hormone receptor β agonists (recently approved), FXR agonists, and PPAR agonists. The review emphasizes that MASLD is a complex, multi-pathway disease involving insulin resistance, oxidative stress, gut-liver axis dysfunction, and genetic/epigenetic factors. When MASLD progresses unchecked, it can lead to cirrhosis and hepatocellular carcinoma (liver cancer). Lifestyle interventions remain foundational, but pharmacological options — particularly peptide-based ones — offer new hope for the large population affected.

Why it matters

MASLD affects roughly 25-30% of the global population and is becoming the leading cause of liver transplantation. Until very recently, there were no approved drug treatments. GLP-1 agonists and multi-agonist peptides represent some of the most promising pharmacological approaches because they address the metabolic root causes — insulin resistance, obesity, and inflammation — rather than just the liver symptoms.

The numbers in context

MASLD affects ~25-30% of adults globally · Can progress to MASH → cirrhosis → liver cancer · GLP-1, GLP-1/GIP, and GLP-1/GIP/glucagon agonists under investigation · THR-β agonist newly approved

How the study worked

State-of-the-art narrative review published in the Journal of the Chinese Medical Association, covering diagnosis, treatment (lifestyle, pharmacological, surgical), and the MASLD-to-HCC progression pathway. Surveys emerging drug classes with emphasis on peptide-based therapies.

Who was studied

Not applicable (review covering the global MASLD/MASH patient population)

What this study cannot tell us

Narrative review without systematic methodology. Published in a regional medical journal with limited impact factor. Does not provide detailed efficacy data for specific peptide drugs or head-to-head comparisons. The rapidly evolving nature of MASLD therapeutics means some information may become outdated quickly.

How to read the evidence

This is a narrative review from a regional medical journal, synthesizing current evidence on MASLD treatment. While informative, it lacks the systematic rigor of Cochrane-level reviews and draws from a field where clinical trial data is still emerging for many of the peptide drugs discussed.

When this study was published

Published in 2025. Reflects the current state of MASLD therapeutics including recently approved treatments and drugs in late-stage clinical trials.

The bigger picture

The GLP-1 revolution is expanding far beyond diabetes and obesity. MASLD/MASH represents one of the largest potential markets for peptide therapeutics — hundreds of millions of patients worldwide with a progressive disease that had no drug treatment until very recently. If GLP-1-based drugs prove effective at halting liver fibrosis, it would be one of the most impactful expansions of peptide therapy in medical history.

Questions still open

Will GLP-1 receptor agonists receive formal approval for MASLD/MASH, or will they remain off-label for this indication?
Do triple agonists (GLP-1/GIP/glucagon) offer meaningful advantages over single GLP-1 agonists for liver disease specifically?
Can peptide-based therapies reverse existing liver fibrosis, or only prevent further progression?

Common questions

Can GLP-1 drugs like semaglutide treat fatty liver disease?

They're being actively studied for this purpose and show promise. GLP-1 agonists address the metabolic root causes of MASLD — insulin resistance, obesity, and inflammation — which can reduce liver fat and potentially slow disease progression. While not yet formally approved for liver disease, they are among the leading candidates in the MASLD treatment pipeline.

What is MASLD and why was the name changed from NAFLD?

MASLD (metabolic dysfunction-associated steatotic liver disease) is the updated name for what was previously called NAFLD (non-alcoholic fatty liver disease). The name was changed to better reflect that the disease is driven by metabolic dysfunction rather than simply being defined by the absence of alcohol use. The inflammatory form, MASH, replaces the old term NASH.

Read the original research

Complexity of metabolic dysfunction-associated steatotic liver disease: State of the art review.

Journal of the Chinese Medical Association : JCMA, 88(9), 662-671

View on PubMed ↗Publisher’s paper ↗

Citation

Yeh, Hsiao-Yun; Lin, Shang-Wei; Shen, Hsiao-Chin; Li, Tzu-Hao; Tsai, Hung-Cheng; Yang, Ying-Ying; Lin, Han-Chieh; Hou, Ming-Chih. (2025). Complexity of metabolic dysfunction-associated steatotic liver disease: State of the art review.. Journal of the Chinese Medical Association : JCMA, 88(9), 662-671. https://doi.org/10.1097/JCMA.0000000000001254