Semaglutide, the popular weight loss and diabetes drug, now has the green light to treat moderate to severe metabolic dysfunction-associated steatohepatitis (MASH) . If you have the condition and are considering your treatment options, you may be wondering whether this GLP-1 receptor agonist is the right choice for you. Available clinical trial data shows that semaglutide can be incredibly helpful for many people with MASH. “It’s not only considered safe for these purposes, but also likely to improve health significantly,” says Jessica Cutler, MD , a weight loss surgeon with the Maryland Bariatric Center at Mercy Medical Center in Baltimore. With that said, it’s not necessarily the best fit for everyone with MASH or related liver conditions.
Semaglutide’s FDA Approval to Treat MASH Semaglutide for MASH In August 2025, semaglutide received an accelerated approval from the U.S. Food and Drug Administration (FDA) as a first-line treatment option for adults with moderate to severe MASH. This decision was based on positive data emerging from an ongoing phase 3 clinical trial, with full approval expected to come once the trial is complete and the FDA reviews the additional data.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b11927f8-a581-4dff-8956-d3097f514495 The FDA decided that semaglutide should receive accelerated approval for MASH after early results were so positive. After 72 weeks, 63 percent of patients receiving semaglutide resolved their MASH and didn’t experience worse liver scarring or fibrosis, compared with 34 percent of those taking a placebo. Additionally, 37 percent of patients receiving semaglutide improved their liver fibrosis without their MASH worsening, compared with 22 percent of those taking a placebo.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b11927f8-a581-4dff-8956-d3097f514495 The trial is planned to last a total of 240 weeks, at which point the FDA will look to see whether patients’ improvements in liver inflammation and scarring observed after 72 weeks resulted in fewer deaths, liver transplants, and other liver-related health events.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b11927f8-a581-4dff-8956-d3097f514495 Semaglutide improves MASH by addressing two of its underlying causes: excess body fat and high blood sugar . Both lead to excess fat accumulation and inflammation in the liver, which can lead to scarring or fibrosis over time.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bb7ad7f6-4ffa-4ea8-ae16-bb9f8945d51f “By inducing weight loss and improving metabolic health, semaglutide can decrease toxicity from fat accumulation and liver cell damage, allowing the liver to heal and achieve fibrosis regression,” says Naim Alkhouri, MD , hematologist and chief medical officer at Summit Clinical Research in Phoenix.
People With Diabetes People With Diabetes Semaglutide is sold under two brand names: Wegovy (for weight loss) and Ozempic (for diabetes). Only Wegovy is officially approved for MASH. The clinical trial exploring the use of semaglutide as a treatment for MASH is testing a weekly 2.4 milligram (mg) dose, the maximum Wegovy dose, which is slightly higher than the maximum weekly 2 mg dose that’s approved for Ozempic to treat diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629660ccc11-e05e-4195-9abb-7b83f691adea Those who have MASH and diabetes and are already taking semaglutide for the latter may be wondering whether the medication can effectively treat their MASH as well. The answer isn’t yet clear due to the slight difference in these doses. “Patients already on semaglutide for diabetes who want to treat MASH should talk to their provider to see if dose escalation is right for them,” says A. Sidney Barritt IV, MD , director of hepatology at UNC School of Medicine in Chapel Hill, North Carolina.
People Without Obesity People Without Obesity Not everyone with MASH has obesity. Sometimes people with risk factors like high cholesterol or high blood pressure can develop MASH even though their body mass index (BMI) is considered healthy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b34ce1ca-f81f-401e-badc-a4d99cc93b9c If you’re in that camp, semaglutide may not be as effective at treating your MASH as those who have obesity, the data suggest.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ec7d02cf-82b7-47bc-816e-9ca115fd3fbc “[Because] the semaglutide benefit is mostly indirect through control of weight and diabetes, patients without these comorbidities may not receive the same benefits,” says Dr. Barritt. Instead, it may be worth asking your doctor about other treatment options like resmetirom , which helps improve MASH without weight loss.e60dc2a1-f33c-4a05-9b50-8e3e8e59762919f76c89-25b3-4811-9f8b-5b6ebcf3a375
Older Adults Older Adults Semaglutide is approved to treat adults of all ages with moderate to severe MASH, but if you’re over 60 years old, there are a few concerns of which to be aware. Rapid weight loss from a GLP-1 puts older adults at higher risk for muscle loss, which may lead to frailty and injuries that make it harder to perform daily activities independently.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294df1a613-6029-4145-b8b3-575b9e046cf6 Older age may also make you more prone to experiencing GLP-1-related side effects like nausea, constipation, and dehydration.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3d2e99e-413c-4f13-b86a-5cdcc4783a70 And if you’re taking additional medications, which becomes more common with age, you need to make sure none of those medications interact with semaglutide. “With careful monitoring, semaglutide can still be considered an effective and safe tool for older adults with MASH,” says Yasika Garcia, MD , an endocrinologist with Medical Offices of Manhattan in New York City. Discuss the benefits and drawbacks with your doctor to determine whether semaglutide is the right treatment option for you.
Children and Teens Children and Teens MASH may be surprisingly common among children and teens.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ddcdea0-23a2-4932-ba0a-84454e4bd004 While semaglutide is approved to treat obesity in children over 12 years old, it’s not currently approved to treat MASH in those under 18. If your child has MASH, talk with their pediatrician about other ways to improve their liver health, such as dietary changes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290fe9b24c-e3ed-48d3-8bc0-99b7cf51c6dc
Can Semaglutide Treat ‘Fatty Liver’? MASLD Metabolic dysfunction-associated liver disease (MASLD) , sometimes referred to as “fatty liver,” is a milder form of MASH. With MASLD, the liver exhibits some excess fat buildup. With MASH, the fat buildup progresses to the point where it causes liver inflammation and scarring.e60dc2a1-f33c-4a05-9b50-8e3e8e59762969af36ac-4255-4cce-b543-d358379f0b25 At this time, semaglutide is only approved to treat MASH, not MASLD.e60dc2a1-f33c-4a05-9b50-8e3e8e597629424ee913-8f8e-41bc-a33c-e01aab035166 However, weight loss is a cornerstone of MASLD treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e59762969af36ac-4255-4cce-b543-d358379f0b25 So if you have MASLD and you’re overweight or have obesity, your doctor may recommend using semaglutide to reach a healthier weight, which could improve the health of your liver.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ef46657-c3ce-446c-802a-c145232b9c8c
Can Semaglutide Treat Severe Liver Disease? Severe Liver Disease Over time, liver scarring from MASH can lead to severe complications like cirrhosis (advanced liver scarring) or liver failure.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913f2a08a-7588-4310-b06e-fd353d35fe55 It can also increase one’s risk for liver cancer . Semaglutide doesn’t appear to be an effective treatment for these advanced complications and isn’t currently recommended as such.e60dc2a1-f33c-4a05-9b50-8e3e8e59762948f126a3-1a77-4618-a966-8b0c1240afdae60dc2a1-f33c-4a05-9b50-8e3e8e597629bab3b441-ade0-4015-9c72-05fb9dcb7509 It’s also unclear whether the medication is safe for people with cirrhosis. Though it’s not yet understood why, some research suggests that the rapid weight loss caused by semaglutide could potentially worsen liver scarring.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac7b2d03-b560-42df-9c4b-0d733c124349
Warnings and Contraindications Warnings Semaglutide is an effective treatment for MASH, but it’s not appropriate for everyone. You shouldn’t take semaglutide if you have:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295021d812-69f4-4215-9953-7e28a34fc6c3 A personal or family history of medullary thyroid cancer Gastroparesis Multiple endocrine neoplasia type 2 Type 1 diabetes People who are pregnant or breastfeeding should also avoid taking semaglutide.e60dc2a1-f33c-4a05-9b50-8e3e8e597629410be2b8-bcf8-4e4e-ac60-82afc23409ca
The Takeaway The FDA has granted accelerated approval for GLP-1 receptor agonist drug semaglutide as a first-line treatment for adults with moderate to severe MASH. Semaglutide works by addressing underlying causes of MASH — namely excess body fat and high blood sugar — leading to weight loss and improved metabolic health that allow the liver to heal. While generally considered safe, semaglutide may be less effective for patients with MASH who don’t also have obesity or diabetes, poses specific risks for older adults (like muscle loss and side effects), and isn’t approved for children or teens or for those navigating severe complications like cirrhosis. Contraindications for taking semaglutide include a personal or family history of medullary thyroid cancer, gastroparesis, type 1 diabetes, and being pregnant or breastfeeding.
Resources We Trust Cleveland Clinic: 8 Lifestyle Changes to Help Manage MASH U.S. Food and Drug Administration: FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’ Harvard Health Publishing: Diabetes and Obesity Drug Shows Promise for Fatty Liver Disease American Association for the Study of Liver Diseases: Why Are GLP-1 Agonists Being Used to Treat Patients With Nonalcoholic Fatty Liver Disease? American College of Gastroenterology: Semaglutide for the Treatment of Metabolic Dysfunction-Associated Steatohepatitis
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