MASH

Spotlight article

Pemvidutide Shows Broad Liver and Metabolic Improvements in MASH

In the Phase 2b IMPACT trial, 212 adults with biopsy-confirmed metabolic dysfunction-associated steatohepatitis (MASH) and F2 or F3 fibrosis were randomized to weekly pemvidutide, an investigational dual glucagon/GLP-1 receptor agonist, or placebo. At 48 weeks, the 1.8-mg dose was associated with a 54.7% reduction in liver fat vs 8.2% with placebo, along with mean weight loss of 7.5% and reductions in triglycerides, total cholesterol, and LDL cholesterol. Noninvasive fibrosis and inflammation measures also improved: approximately one third of patients receiving 1.8 mg of pemvidutide achieved both a ≥0.5-point reduction in Enhanced Liver Fibrosis score and a ≥30% reduction in liver stiffness, compared with 3.2% receiving placebo. These findings extend earlier 24-week results showing MASH resolution without worsening fibrosis in up to 59.1% of participants.

 

As the MASH treatment landscape evolves, the results highlight the potential of therapies designed to address both hepatic disease and underlying cardiometabolic risk factors. Gastrointestinal adverse events were most common and were generally mild to moderate. About 1% of participants discontinued because of adverse events, and no imbalance in cardiac adverse events was reported. However, pemvidutide remains investigational, the Phase 2b population was relatively small, and the 48-week analysis relied largely on noninvasive hepatic and cardiometabolic measures rather than a repeat biopsy endpoint. A multinational Phase 3 trial is planned to further evaluate the therapy.

 

Reference: McCall B. Pemvidutide Shows Liver and Cardiovascular Benefits in MASH. Medscape. Published May 31, 2026. Accessed September 10, 2026. https://www.medscape.com/viewarticle/pemvidutide-shows-liver-and-cardiovascular-benefits-mash-2026a1000i34

Ashlyn Smith

MMS, PA-C

Physician Associate, Endocrinology and Lifestyle Medicine, PLLC

Featured article

MASLD: Nearly 1 in 5 Met Criteria for Hepatology Referral

A prospective multicenter study of 654 adults with metabolic dysfunction-associated steatotic liver disease (MASLD) seen in diabetology and nutrition clinics evaluated noninvasive strategies for identifying advanced fibrosis. Most participants had type 2 diabetes (87.2%) and obesity (73.7%). Overall, 9.3% were classified as having a high risk of advanced fibrosis, while 17.6% had intermediate or high risk and met the study’s criteria for specialized hepatology care. Among first-line tests, FIB-4 showed an AUROC of 0.78. At a cutoff below 1.30, it ruled out high-risk advanced fibrosis in 54.1% of participants with a negative predictive value of 97.2%.

 

The findings support the recommended two-step strategy of FIB-4 followed by vibration-controlled transient elastography (VCTE) for risk stratification in patients with MASLD and type 2 diabetes and/or obesity. When VCTE is not readily available, 2D shear-wave elastography or the Enhanced Liver Fibrosis blood test may offer alternatives. However, the study found tradeoffs in referral rates and diagnostic performance depending on the thresholds used. In clinical practice, the results reinforce the potential value of structured noninvasive fibrosis assessment to help identify who may warrant hepatology referral. Generalizability is limited because the study was conducted at tertiary centers in France, excluded patients with class III obesity, and did not evaluate whether implementation improved long-term clinical outcomes.

 

Reference: Caussy C, Vergès B, Leleu D, et al. Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease-Related Advanced Fibrosis in Diabetology: A Prospective Multicenter Study. Diabetes Care. 2025 Jun 1;48(6):877-886. doi: 10.2337/dc24-2075. PMID: 39887699. 

Mayra Cantazaro

DNP, FNP-BC, BC-ADM, CDCES

Fatty Liver Apps: Are Patients Getting Reliable Self-Care Support?

A systematic review evaluated 10 free, English-language Android apps designed to support fatty liver self-care using the Mobile Application Rating Scale (MARS). Overall quality scores ranged from 2.37 to 3.48 out of 5, with seven apps meeting acceptable quality standards and three rated poor. Functionality was the strongest domain, averaging 4.2, while engagement averaged 2.62 and information quality 3.21. Only two apps cited references for their content, and the investigators noted that the validity of the information provided could not be determined.

 

When counseling patients about digital self-care tools, the findings highlight the importance of looking beyond app-store ratings when discussing digital self-care tools. Apps may offer features such as dietary guidance, medication reminders, disease information, and access to educational content, but quality, engagement, and evidence transparency varied considerably. The findings should be interpreted cautiously because the review was limited to Android apps available in early 2024, excluded some apps because of access or login restrictions, and did not evaluate whether app use improved clinical outcomes. The authors call for greater collaboration among developers, patients, and healthcare professionals to create more reliable, engaging, and practical self-care tools.

Reference: Mohammadzadeh N, Daeechini AH, Paghe A, et al. Evaluation of fatty liver disease self-care applications: a systematic review and evaluation of apps using the mobile application rating scale (MARS). BMC Gastroenterol. 2026 Jun 15;26(1):521. doi: 10.1186/s12876-026-05001-2. PMID: 42298386. 

Sarah Enslin

PA-C

MASH: Semaglutide Improves Resolution—but What About Fibrosis?

A systematic review and meta-analysis of four placebo-controlled randomized trials found that semaglutide significantly increased the likelihood of steatohepatitis resolution without worsening fibrosis in adults with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) (RR, 2.14; 95% CI, 1.44-3.17; P = .0002). Semaglutide also was associated with greater weight loss and significantly lower HbA1c and AST levels compared with placebo. However, it did not significantly improve fibrosis without worsening steatohepatitis (RR, 1.14; P=.67) or liver stiffness, underscoring an important distinction between improvements in steatohepatitis and evidence of fibrosis regression.

 

For nurse practitioners and physician associates managing patients with MASH-many of whom also have obesity or type 2 diabetes-the findings highlight semaglutide’s potential to address both hepatic and metabolic disease while leaving questions about its antifibrotic effects. Gastrointestinal adverse events, including nausea, diarrhea, and vomiting, occurred more frequently with semaglutide, although rates of severe adverse events and treatment discontinuation did not differ significantly from placebo. Interpretation is limited by substantial heterogeneity for several outcomes, differing doses and study designs, and follow-up of only 48-72 weeks, emphasizing the need for longer-term data on fibrosis and clinical outcomes.

 

Reference: Khan S, Jamal A, Qadri M, et al. Therapeutic role of semaglutide in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: A systematic review and meta-analysis of placebo-controlled trials with GRADE evidence assessment. Medicine (Baltimore). 2026 Jul 24;105(30):e49916. doi: 10.1097/MD.0000000000049916. PMID: 42499082; PMCID: PMC13406235.

Sarah Enslin

PA-C

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