The use of pharmacotherapies in non-cirrhotic metabolic dysfunction-associated steatohepatitis: a UK expert consensus

TY - JOUR

T1 - The use of pharmacotherapies in non-cirrhotic metabolic dysfunction-associated steatohepatitis

T2 - a UK expert consensus

AU - Cobbold, Jeremy F.

AU - Miller, Hamish

AU - Hallsworth, Kate

AU - Manousou, Pinelopi

AU - Marjot, Thomas

AU - Allison, Michael E.D.

AU - Anstee, Quentin M.

AU - Armstrong, Matthew J.

AU - Avery, Leah

AU - Azzu, Vian

AU - Brennan, Paul N.

AU - Byrne, Christopher D.

AU - Cacciottolo, Tessa M.

AU - Corless, Lynsey

AU - Forton, Daniel

AU - Hardy, Timothy

AU - Hebditch, Vanessa

AU - Jarvis, Helen

AU - Li, Wenhao

AU - Mansour, Dina

AU - McPherson, Stuart

AU - Miao, Yensiew

AU - Morling, Joanne R.

AU - Mukhopadhya, Ashis

AU - Mullish, Benjamin H

AU - Parker, Richard

AU - Patanwala, Imran

AU - Patel, Jay

AU - Pavlides, Michael

AU - Reinson, Tina

AU - Rowe, Ian A.

AU - Saffioti, Francesca

AU - Shaikh, Faisal

AU - Srivastava, Ankur

AU - Than, Nwe Ni

AU - Tsochatzis, Emmanuel A.

AU - Volcek, Edvard

AU - Tomlinson, Jeremy W.

AU - Alazawi, William

N1 - Copyright: © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

PY - 2026/4/30

Y1 - 2026/4/30

N2 - Metabolic dysfunction-associated steatohepatitis (MASH), a potentially progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) increases risk of fibrosis progression, cirrhosis, liver-related and cardiometabolic morbidity. The first licensed pharmacotherapies, resmetirom and semaglutide, mark a shift in management but practical guidance for real-world implementation is lacking. The British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG) MASLD Special Interest Group (SIG) developed consensus recommendations on patient selection, lifestyle management and follow-up for MASLD/MASH-specific pharmacotherapy. Thirty-six participants participated in a Delphi process: draft statements developed in working groups were anonymously rated, discussed and refined. Consensus (≥80% agreement) was reached for 49 statements. Two-step non-invasive tests (NITs) including FIB-4, transient elastography are recommended to identify patients with presumed stage F2–F3 fibrosis (“at-risk MASH”). Individuals with liver stiffness >10kPa but without evidence of cirrhosis should be considered eligible for treatment. Lifestyle behaviour change intervention should accompany pharmacological treatment, delivered by suitably-trained practitioners without delaying access to medication. Treatment discontinuation is advised with evidence of disease progression, cirrhosis development or drug-induced liver injury. These recommendations offer pragmatic guidance to clinicians and consensus clinical opinion to regulatory bodies to support equitable and effective use of new MASLD/MASH therapies.

AB - Metabolic dysfunction-associated steatohepatitis (MASH), a potentially progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) increases risk of fibrosis progression, cirrhosis, liver-related and cardiometabolic morbidity. The first licensed pharmacotherapies, resmetirom and semaglutide, mark a shift in management but practical guidance for real-world implementation is lacking. The British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG) MASLD Special Interest Group (SIG) developed consensus recommendations on patient selection, lifestyle management and follow-up for MASLD/MASH-specific pharmacotherapy. Thirty-six participants participated in a Delphi process: draft statements developed in working groups were anonymously rated, discussed and refined. Consensus (≥80% agreement) was reached for 49 statements. Two-step non-invasive tests (NITs) including FIB-4, transient elastography are recommended to identify patients with presumed stage F2–F3 fibrosis (“at-risk MASH”). Individuals with liver stiffness >10kPa but without evidence of cirrhosis should be considered eligible for treatment. Lifestyle behaviour change intervention should accompany pharmacological treatment, delivered by suitably-trained practitioners without delaying access to medication. Treatment discontinuation is advised with evidence of disease progression, cirrhosis development or drug-induced liver injury. These recommendations offer pragmatic guidance to clinicians and consensus clinical opinion to regulatory bodies to support equitable and effective use of new MASLD/MASH therapies.

U2 - 10.1016/S2468-1253(26)00077-4

DO - 10.1016/S2468-1253(26)00077-4

M3 - Review article

C2 - 42070581

SN - 2468-1253

JO - The Lancet Gastroenterology and Hepatology

JF - The Lancet Gastroenterology and Hepatology

ER -