Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called non-alcoholic fatty liver disease (NASH), affects nearly one-third of the US population (over 100 million people). Obesity is thought to be the most common cause. In some cases, MASLD can develop into a more serious condition called metabolic dysfunction-associated steatohepatitis (MASH). Both conditions develop when the liver stores too much fat. In cases of MASH, this extra fat causes inflammation, which can eventually lead to scarring, also known as fibrosis.
Around 5% to 7% of adults with MASLD develop MASH. If left untreated, MASH can lead to severe complications like cirrhosis, liver failure, or liver cancer.
Recent research has explored how Wegovy, a medication that delivers semaglutide and is now commonly used for type 2 diabetes and obesity, might help treat MASH. In one study, patients with MASH and moderate liver scarring showed significant improvements when taking semaglutide, with nearly 60% of those on the highest dose seeing reduced liver inflammation compared to just 17% in the placebo group. While its impact on liver scarring wasn’t as clear, these findings suggest Wegovy could play an important role in addressing fatty liver disease.
The trial results show that semaglutide, a GLP-1 RA drug, also contained in Ozempic and Mounjaro, can treat more than just diabetes and obesity. In recent years, these drugs have been approved for other conditions. For example, Wegovy was approved to lower the risk of heart disease in people with obesity, and Zepbound was approved to treat obstructive sleep apnea. Ozempic was also approved to help manage chronic kidney disease in people with type 2 diabetes. Researchers are now studying whether these drugs could also help with Alzheimer’s disease and alcohol addiction.
What are the treatments currently available for MASH?
Currently, only one drug has received approval from the FDA for treating MASH in patients with stage 2 or 3 liver fibrosis. Ongoing studies are being conducted to confirm its clinical benefits for full approval. However, it only works for about 25% of patients and doesn’t treat the root causes of the disease. For those who can’t improve the condition through lifestyle changes, bariatric surgery is often recommended. There is still a need for more treatment options, especially because patients with MASH have a higher risk of liver problems and heart disease. Ideally, treatments should target both issues. 
Are trials underway for Wegovy to treat fatty liver disease?
Currently, there is a trial in progress called the ESSENCE trial. The trial has so far compared weekly injections of semaglutide (2.4 mg) to a placebo in patients with confirmed MASH and moderate to severe liver scarring (stage 2 or 3 fibrosis).
This phase 3 trial is ongoing and involves multiple centers, with 253 clinical sites across 37 countries. The main goals of the trial are to study specific tissue changes in the first part and to track clinical outcomes in the second. The outcomes will be shared once the trial ends. The results shared below come from an analysis completed after 72 weeks, focusing on the first 800 participants. The study is still in progress and remains blinded to continue evaluating survival without cirrhosis after 240 weeks.
ESSENCE Trial interim results
In the first part of the trial, researchers focused on two main goals. The first was improving liver health without making other issues worse. This involved resolving steatohepatitis, which meant reducing swelling and damage in the liver without increasing liver scarring. The second goal was reducing liver fibrosis by at least one stage, without worsening steatohepatitis. Steatohepatitis was considered worse if there was an increase in swelling, inflammation, or fat buildup in the liver. In the second part of the trial, the main outcome being studied is how long participants remain free of cirrhosis.
The differences between the groups were significant. The first outcome showed improvement in steatohepatitis without their liver fibrosis getting worse after 72 weeks. This was seen in 62.9% of patients.
The second outcome, a reduction in liver fibrosis without worsening steatohepatitis, occurred in 36.8% of the semaglutide group. These results were consistent, regardless of whether the participants had type 2 diabetes, obesity, or differences in age, sex, or liver damage stage. Overall, the results suggest semaglutide could be effective in treating MASH for people with stage 2 or 3 fibrosis.
Were there any side effects in the trial?
In the trial, there were no new safety concerns, and the results matched what is already known about semaglutide. The most common side effects were related to the digestive system, like nausea, diarrhea, constipation, and vomiting. and no liver-related issues or other new safety problems were found.
When will Wegovy be approved to treat fatty liver disease?
The FDA is expected to decide whether to approve Wegovy for treating MASH by the end of the year, and they have also given the drug a priority review, which shortens the review process to six months instead of the usual nine. The trial resulted in a major breakthrough, which could change the way treatments are approached because there isn’t another drug like it in this area yet. Once patients develop fibrosis, it can be very hard to treat or reverse. The fact that semaglutide not only reduced inflammation but also led to fibrosis improvement is really promising news.
Frequently Asked Questions About Fatty Liver Disease
Can Ozempic fix fatty liver?
The active ingredient in Ozempic and Wegovy, a drug known as semaglutide, could potentially reverse symptoms of liver disease. Research suggests that this medication, commonly used for diabetes management and weight loss, may also benefit individuals suffering from a severe type of fatty liver disease called MASH. Trials so far have involved higher concentrations of semaglutide (2.4mg weekly) than can be obtained from regular Ozempic doses (maximum strength 1 mg), so the drug-of-choice will be Wegovy.
Does Ozempic get rid of visceral fat?
Ozempic helps decrease appetite and slow down digestion, leading many people to lose a noticeable amount of belly fat, including the deeper visceral fat. As a result, patients often achieve a slimmer and healthier body composition.
What is the best natural treatment for severe fatty liver?
Metabolic associated fatty liver disease often requires lifestyle changes to manage effectively. Doctors typically recommend following a healthy diet while cutting back on sugar, losing weight, and exercising regularly. It’s also important to control blood sugar levels, address high cholesterol if present, and avoid medications that may harm the liver. Limiting alcohol consumption, quitting smoking, and making overall healthier choices can help improve liver health and reduce complications.
Is fatty liver 100% curable?
Fatty liver currently has no medical or surgical treatments, but some steps can help prevent or even reverse some of the damage. For those with fatty liver, especially if diagnosed with NASH, it is important to focus on safe weight loss. Experts recommend losing weight gradually, aiming for about 1 to 2 pounds (0.5 to 1 kilogram) per week to achieve the best results.
How fast can a fatty liver heal?
The time it takes to reverse fatty liver disease varies depending on its cause. For individuals with alcohol-induced fatty liver, the condition may improve within about two weeks of abstaining from alcohol. In cases of non-alcoholic fatty liver disease (NAFLD/NASH), the recovery timeline depends on the rate of weight loss. However, it’s important to approach weight loss gradually, as losing weight too quickly can have negative health effects.
