Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China.
Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Curr Obes Rep. 2024 Dec;13(4):818-830. doi: 10.1007/s13679-024-00582-z. Epub 2024 Aug 7.
The approval of resmetirom brings great hope to patients with metabolic dysfunction-associated steatohepatitis (MASH). The purpose of this review is to explore its impact on the global health environment. The implementation of multidisciplinary management MASH is proposed.
Resmetirom has benefits in the treatment of MASH, and its safety and effectiveness have been studied. The adverse events (AEs) need to be noticed. To improve patient outcomes, a multimodal approach with medication such as resmetirom, combined with metabolic and bariatric surgery (MBS) and lifestyle interventions can be conducted. MASH, a liver disease linked with obesity, is a challenging global healthcare burden compounded by the absence of any approved pharmacotherapy. The recent conditional approval by the Food and Drug Administration (FDA) in the United States of resmetirom, an oral, liver-directed, thyroid hormone receptor beta-selective agonist, marks a significant milestone, offering a treatment option for adults with non-cirrhotic MASH and who have moderate to advanced liver fibrosis. This narrative review discusses the efficacy and safety of resmetirom and its role in the therapeutic landscape of MASH treatment. Despite the promising hepatoprotective effect of resmetirom on histological liver endpoints, its use need further research, particularly regarding ethnic differences, effectiveness and cost-effectiveness, production scalability, social acceptance and accessibility. In addition, integrating resmetirom with other multidisciplinary therapeutic approaches, including lifestyle changes and MBS, might further improve clinical liver-related and cardiometabolic outcomes of individuals with MASH. This review highlights the importance of a comprehensive treatment strategy, supporting continued innovation and collaborative research to refine treatment guidelines and consensus for managing MASH, thereby improving clinical patient outcomes in the growing global epidemic of MASH. Studies done to date have been relatively short and ongoing, the course of the disease is highly variable, the conditions of various patients vary, and given this complex clinical phenotype, it may take many years of clinical trials to show long-term benefits.
代谢功能障碍相关脂肪性肝炎（MASH）患者迎来了 resmetirom 获批的重大希望。本文旨在探讨其对全球健康环境的影响，并提出多学科管理 MASH 的实施建议。
resmetirom 可改善 MASH 患者的病情，其安全性和有效性已得到研究证实，但仍需关注不良反应。为改善患者结局，可采用多模式治疗方法，如使用 resmetirom 等药物，联合代谢和减重手术（MBS）及生活方式干预。MASH 是一种与肥胖相关的肝脏疾病，由于缺乏任何已批准的药物治疗方法，它是全球医疗保健面临的一项具有挑战性的负担。最近，美国食品和药物管理局（FDA）有条件批准了一种口服、肝脏靶向、甲状腺激素受体β选择性激动剂 resmetirom，这为非肝硬化 MASH 且伴有中度至重度肝纤维化的成年患者提供了一种治疗选择，这是一个重要的里程碑。本文对 resmetirom 的疗效和安全性及其在 MASH 治疗中的作用进行了讨论。尽管 resmetirom 在组织学肝脏终点方面具有有前景的肝保护作用，但它的使用仍需要进一步研究，特别是关于种族差异、有效性和成本效益、生产可扩展性、社会接受度和可及性。此外，将 resmetirom 与其他多学科治疗方法（包括生活方式改变和 MBS）相结合，可能会进一步改善 MASH 患者的临床肝脏相关和心脏代谢结局。本文强调了综合治疗策略的重要性，支持持续创新和协作研究，以完善治疗指南和共识，从而改善 MASH 这一日益严重的全球流行疾病患者的临床结局。迄今为止，已开展的研究相对较短，且正在进行中，疾病的病程高度可变，不同患者的病情也各不相同，鉴于这种复杂的临床表型，可能需要多年的临床试验才能显示出长期获益。
