Singh Anmol, Sohal Aalam, Batta Akash
Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States.
Division of Gastroenterology, Creighton University School of Medicine, Phoenix, AZ 85012, United States.
World J Gastroenterol. 2024 Dec 28;30(48):5205-5211. doi: 10.3748/wjg.v30.i48.5205.
The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 32.4%, reflecting its growing clinical significance. MASLD, which includes MASLD and metabolic dysfunction-associated steatohepatitis (MASH) has been linked to increased metabolic, cardiovascular, and malignant morbidity. Progression into fibrotic stages of MASLD is also strongly associated with liver-related mortality. The past few years have seen a heightened focus on creating innovative therapeutic strategies for MASH management. GLP-1 receptor agonists (RA) have also emerged as a potential treatment option. Studies on GLP-1 agonists, such as liraglutide and semaglutide, have demonstrated efficacy in MASH management, albeit with limited histological improvement of fibrosis. However, recent investigations into GLP-1/GIP RA (tirzepatide) and Glucagon/GLP-1 RA (survodutide) have shown even more encouraging results, with higher rates of MASH resolution and fibrosis improvement. The tolerability of these medications due to their gastrointestinal side effects remains a major concern. Future research should focus on optimizing drug regimens, identifying patients most likely to benefit, and balancing efficacy with tolerability. The evolving landscape of MASH therapeutics suggests a bright future, with the potential for combination therapies to further enhance patient outcomes.
代谢功能障碍相关脂肪性肝病（MASLD）的全球患病率估计为32.4%，这反映了其日益增长的临床重要性。MASLD包括脂肪性肝病和代谢功能障碍相关脂肪性肝炎（MASH），与代谢、心血管和恶性疾病发病率的增加有关。进展到MASLD的纤维化阶段也与肝脏相关死亡率密切相关。在过去几年中，人们越来越关注为MASH管理制定创新的治疗策略。胰高血糖素样肽-1受体激动剂（RA）也已成为一种潜在的治疗选择。对利拉鲁肽和司美格鲁肽等胰高血糖素样肽-1激动剂的研究表明，它们在MASH管理中具有疗效，尽管对纤维化的组织学改善有限。然而，最近对胰高血糖素样肽-1/葡萄糖依赖性促胰岛素多肽受体激动剂（替尔泊肽）和胰高血糖素/胰高血糖素样肽-1受体激动剂（司沃得肽）的研究显示了更令人鼓舞的结果，MASH缓解率和纤维化改善率更高。由于其胃肠道副作用，这些药物的耐受性仍然是一个主要问题。未来的研究应侧重于优化药物治疗方案，确定最可能受益的患者，并在疗效和耐受性之间取得平衡。MASH治疗学不断变化的格局预示着一个光明的未来，联合治疗有可能进一步改善患者的预后。
