How Semaglutide Treats MASH: The Science Explained
Health ConditionsLiver Disease

How Semaglutide Improves MASH

How Semaglutide Improves MASH
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Published on December 18, 2025
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Semaglutide is a glucagon-like peptide-1 receptor (GLP-1) medication primarily used to manage obesity and diabetes. The U.S. Food and Drug Administration (FDA) also has approved it under the brand name Wegovy to treat the liver condition metabolic dysfunction-associated steatohepatitis (MASH).

 Only one other medication — resmetirom (Rezdiffra) — is FDA-approved to treat MASH.

MASH occurs when excess fat causes liver inflammation. Semaglutide improves MASH by reducing body fat and improving metabolic function, which decreases liver fat, inflammation, and scarring. It has an indirect effect, says A. Sidney Barritt IV, MD, director of hepatology at University of North Carolina School of Medicine in Chapel Hill, North Carolina, by improving risk factors that can affect liver health.

How Liver Fat and MASH Are Connected

Once referred to as nonalcoholic fatty liver disease, MASH can happen when you have a fatty buildup called steatosis in your liver. It can lead to inflammation and the formation of scar tissue in the liver, two hallmarks of MASH.

MASH is more likely to occur in people who have obesity and related health conditions, including hypertension, high cholesterol, and prediabetes or type 2 diabetes. It also shares some of the same risk factors as these other conditions, including physical inactivity and a diet high in sugar and saturated fat.

Reducing fat in the liver can help curb liver inflammation and stop or potentially reverse liver scarring.

“With less fat and inflammation, the liver can work on repairing itself,” says Yesika Garcia, MD, an endocrinologist at the Medical Offices of Manhattan in New York City.

Weight Loss

Weight loss may be the most significant benefit for liver health for people who use semaglutide for MASH. Semaglutide reduces appetite and slows digestion, which can help you lose weight.

 Losing as little as 3 to 5 percent of your body weight can help reduce the fat in your liver, and losing 7 percent of your weight can reduce liver inflammation.

This can have a positive effect on people with MASH. Research shows that people with MASH who take 2.4 milligrams of semaglutide once per week can lose as much as 10 percent of their body weight after 72 weeks.

Metabolic Health

GLP-1 drugs such as semaglutide also have a demonstrated ability to improve conditions such as high blood sugar, high blood pressure, and high cholesterol, all of which can also help people with MASH.

Semaglutide can help the body make more insulin and improves insulin sensitivity, which in turn lowers blood-glucose levels and improves blood-sugar control.

 The benefits are wide: About 35 percent of people with type 2 diabetes also have MASH, and many people with MASH already have high blood sugar and may be prediabetic.

High blood sugar and liver damage have a cyclical relationship. Consistently high blood sugar can cause insulin resistance and chronic inflammation, which can lead to fat buildup in the liver that causes more inflammation. This eventually results in the buildup of liver scar tissue, or fibrosis, that can worsen insulin resistance.

Although the FDA has approved the semaglutide Wegovy to treat MASH but not type 2 diabetes, it has approved the semaglutides Ozempic and Rybelsus to treat type 2 diabetes (but not MASH specifically).

High blood pressure and high cholesterol also are risk factors and complications of MASH.

 Even among people without a hypertension diagnosis, higher-than-normal blood pressure can increase the risk of liver scarring for people with MASH.

 High cholesterol levels accelerate fat accumulation in the liver once it already has built up there.

 Research has shown that semaglutide can improve each of these risk factors.

Liver Scarring

Excess body fat and high blood sugar can lead to fat buildup and inflammation in the liver, which over time causes liver scarring or fibrosis. If left untreated, fibrosis can lead to permanent liver damage and increase the risk for liver failure or liver cancer.

Research has shown that semaglutide may stop fibrosis from progressing in more than 60 percent of people with MASH, and it may improve fibrosis in 37 percent of them.

Use of semaglutide also may directly improve liver inflammation, but more research is needed to understand how and why. These improvements may be the result of weight loss and better blood-sugar control, as well.

The FDA has not approved semaglutide to treat cirrhosis, or severe liver scarring, however.

Can Semaglutide Reverse MASH?

In some cases, yes: Research has shown that MASH symptoms resolved in nearly two-thirds of people with MASH after they took semaglutide for 72 weeks.

But semaglutide is not necessarily a cure for MASH, Dr. Barritt says. It is meant to be used alongside lifestyle changes such as eating a healthy diet and exercising, which bolster weight loss and blood sugar control.

“It’s more accurate to say that semaglutide can put MASH into remission,” Barritt says.

If you have MASH and are taking semaglutide, your doctor may assess your progress by checking your liver enzymes, conducting liver imaging tests, or taking a liver biopsy, Dr. Garcia says.

Stopping semaglutide often may cause you to regain weight and see higher blood-sugar levels, which could increase liver fat and inflammation.

 More research also is required to understand semaglutide’s long-term effects on liver health.

The Takeaway

  • The GLP-1 semaglutide improves MASH indirectly by reducing body fat and improving metabolic function, which can decrease fatty buildup, inflammation, and scarring in the liver.
  • Research has shown that semaglutide use over time may resolve MASH in nearly two-thirds of people with the liver condition, though stopping use of the medication could cause MASH to reappear.
  • The FDA has approved semaglutide under the brand name Wegovy to address MASH specifically, though other semaglutide brands Ozempic and Rybelsus are approved to treat type 2 diabetes, which is often related to MASH.

Resources We Trust

EDITORIAL SOURCES
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Resources
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