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ForumsMASH / Liver DiseaseDe novo lipogenesis reduction on GLP-1 — looking for input

De novo lipogenesis reduction on GLP-1 — looking for input

kate.chem Sat, Mar 28, 2026 at 11:30 AM 30 replies 896 viewsPage 1 of 6
kate.chem
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Mar 28, 2026 at 11:30 AM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

The liver data is among the strongest non-weight findings in the class. The semaglutide MASH programme reported a large advantage over placebo on MASH resolution, with a substantial minority also achieving fibrosis improvement — and fibrosis is the endpoint that predicts outcomes. Mechanistically it is reduced hepatic lipogenesis, increased fatty-acid oxidation, less hepatic inflammation, and possibly a direct effect on stellate-cell activation.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

What would genuinely help is knowing whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is. Practical detail welcome, however dull — the duller the better.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
40 10steve_okc, dave_SLC, FDA_TrackerJim and 37 others
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SarahChen_PharmD
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Mar 28, 2026 at 11:39 AM#2
kate.chem said:
The liver data is among the strongest non-weight findings in the class.

Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 11 months on GLP-1 therapy:

MarkerBaselineCurrentNormal Range
ALT69317-56 U/L
AST572110-40 U/L
GGT94339-48 U/L
ALP1048644-147 U/L

FibroScan also improved — liver stiffness from 10.5 kPa to 6.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.

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Dr.RaviCardio
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Mar 28, 2026 at 11:48 AM#3
kate.chem said:
The liver data is among the strongest non-weight findings in the class.

Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 318 dB/m (moderate steatosis) and stiffness 8.8 kPa (possible fibrosis). Diagnosed with NAFLD.

After 10 months: CAP dropped to 231 dB/m (minimal steatosis) and stiffness normalized to 5.3999999999999995 kPa. Hepatologist says the liver is essentially healing itself as the metabolic stress resolves.

GLP-1 agonists may become first-line NASH therapy. The Phase 3 data on semaglutide for NASH is very promising.

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TinaHashiRN
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Mar 28, 2026 at 11:57 AM#4
Dr.RaviCardio said:
Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 318 dB/m (moderate steatosis) and stiffness 8.8 kPa (possible…

ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase 3 ATTAIN trial. NASH resolution was achieved in ~60% of patients[1].

This is relevant to liver and MASH because survodutide's glucagon agonism specifically targets hepatic lipid metabolism — making it potentially the best-in-class agent for NASH/MAFLD comorbid with obesity.

References:
[1] Sanyal AJ, et al. N Engl J Med. 2024.
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tony_orlando
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Mar 28, 2026 at 12:42 PM#5
SarahChen_PharmD said:
Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD).

This matches mine closely enough to be worth saying so out loud.

Last edited: Mar 28, 2026 at 1:42 PM
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