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Colon cancer recurrence risk falls below 0.5% at 6 years post-surgery, offering a practical benchmark for defining cure, according to new research.

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Julia is an associate editor for The American Journal of Managed Care® (AJMC®) and joined AJMC® in 2022. She produces written and video content covering multiple disease states, and assists in the screening process for manuscripts submitted to AJMC®.

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Lurbinectedin has been approved to be used in combination with atezolizumab or atezolizumab and hyaluronidase.

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 in 2023, where she produces written content covering multiple disease states.

She has a BA in journalism from Seton Hall University. You can connect with Brooke on 

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These patients had a higher spleen-to-liver stiffness ratio than those with alcohol-related liver disease, warranting a closer look at testing.

Higher Spleen-to-Liver Stiffness Ratio in MASH May Signal Portal Hypertension

By 2040, advanced metabolic dysfunction–associated steatohepatitis (MASH) is projected to rise by at least 20% in the 9 countries assessed.

Global MASH Burden Projected to Double Costs, Raise Mortality Without Intervention

The treatment also showed signs of metabolic gains, with more benefit seen with the 50-mg dose than the 28-mg.

Efruxifermin Shows Durable Antifibrotic Benefit at 96 Weeks in MASH

The global incidence, deaths, and disability-adjusted life years tied to metabolic dysfunction–associated steatohepatitis (MASH)-related liver cancer have more than doubled in older adults since 1990, with a heavy impact on low- and middle-income countries.

Global Burden of MASH-Related Liver Cancer Rising Sharply Among Older Adults

Approval was based on part 1 of the ESSENCE trial, with part 2 results expected in 2029.

FDA Approves Semaglutide for MASH With Fibrosis

Early Identification of MASLD/MASH Saves Lives: Naim Alkhouri, MD

), Naim Alkhouri, MD, FAASLD, DABOM, chief medical officer, chief of transplant hepatology, and director of the Steatotic Liver Program at Arizona Liver Health pointed to one of the primary obstacles impeding progress in metabolic dysfunction-associated steatotic liver disease (MASLD) and 

metabolic dysfunction-associated steatohepatitis

Earlier identification and treatment initiation for patients with MASLD/MASH are critical for improving outcomes, he added; however, insufficient educational programs and awareness initiatives are having negative consequences for patients and clinicians seeking to manage these conditions.

, Alkhouri spoke to the potential avenues clinicians and health systems can take to address this gap, increase access to essential services, and improve patient outcomes.

This transcript has been lightly edited; captions were auto-generated.

How can clinicians and providers effectively address gaps in MASH awareness?

It takes a village to increase awareness. In patients with type 2 diabetes, for example, the epidemiologic data showed that up to 60% can have steatotic liver disease.

 But then when you look at ICD-10 codes, having the diagnosis in their chart, we talk about 5%-10%. We have a big gap that we need to work on.

I think to do this, we need more educational programs. We need more programs like what [

 is] doing, more websites that target primary care physicians and endocrinologists. We need a campaign that targets also the public and raises awareness about the available treatment options and the available diagnostic tools. We also need to work with the WHO and other organizations on having policies in most countries to tackle MASLD and MASH. We are working on ICD-10 codes also that reflects the entire spectrum of steatotic liver disease, and we need to have screening for MASLD and for risk stratification of patients to become a quality metric that PCPs and endocrinologists have to document every time they see a patient who is at high risk, such as those with type 2 diabetes.

Until this becomes a quality metric, we will continue to have issues with identifying these patients and, more importantly, risk stratifying them. At the end of the day, many patients with steatotic liver disease, MASLD, may not have any fibrosis, and their prognosis is very good long term. Most likely, they will die from heart disease and extra hepatic cancer like the rest of the population, and they have very low chances of progressing to cirrhosis or developing significant liver outcomes.

Doing this at the moment you diagnose MASLD, giving peace of mind to some patients, and maybe following them every 2-3 years will be a very good pathway for the majority of patients. But then the 20%-30% of patients that are at risk of having significant and advanced fibrosis, we could be saving lives by early identification and early treatment. That's why it's more important than ever today to find these patients, because we do have FDA-approved treatments, and we expect to have more in the near future.

1. Epidemiology of non alcoholic fatty liver disease. PrimaryCare notebook. Updated November 17, 2022. Accessed May 5, 2025. https://primarycarenotebook.com/pages/general-information/non-alcoholic-steatosis/epidemiology-of-non-alcoholic-fatty-liver-disease-nafld?utm_source=chatgpt.com

Lacking awareness of metabolic dysfunction-associated steatohepatitis (MASH) constitutes a critical barrier for enhancing patient care, said Naim Alkhouri, MD. Awareness efforts can not only increase patient access, but also improve the overall wellbeing, experience, and outcomes for this population. 

MASH

Providers

Increased Awareness, Novel Interventions, Spell New Era for MASLD/MASH: Naim Alkhouri, MD

By the end of this decade, patients with 

metabolic dysfunction–associated steatohepatitis

 (MASH) cirrhosis could have their first approved treatment, explained Naim Alkhouri, MD, FAASLD, DABOM, chief medical officer, chief of transplant hepatology, and director of the Steatotic Liver program, Arizona Liver Health. With so many new developments and combination therapies in the works for patients with metabolic dysfunction–associated steatotic liver disease (MASLD) and MASH, Alkhouri holds great optimism for the future of MASLD/MASH treatment.

), he explained how the gold standard for MASH management thus far involves a holistic care approach. Simply targeting liver pathology is not enough, he argued. Alkhouri told 

that patients experience the greatest improvements when interventions not only target liver health, heart health, and diabetes control, but also pair medications with lifestyle interventions and weight loss goals.

 the recent advancements and ongoing challenges in MASLD/MASH research. As he continued, he built off these topics and drew attention to innovations on the horizon in MASLD/MASH, and the importance of disease awareness to achieve this progress and enhance patient care.

Where do you see the greatest opportunities for innovation in MASH treatment, and what’s still missing in the current pipeline?

We have a lot of work to be able to make a dent in this epidemic of MASLD and MASH. I think our biggest hurdle is still a lack of awareness and having many patients that may have significant fibrosis—and even advanced fibrosis—that don't have a diagnosis. We need to increase awareness for patients, but also for primary care physicians, endocrinologists, other subspecialists who deal with patients with MASH and significant fibrosis.

We need to also implement screening algorithms on a large scale. Several professional societies now recommend that we utilize the FIB-4 index as a first test to risk stratify patients. This has been around for a few years now, but implementation on a large scale is still lacking. As we said, also, we have an opportunity with the noninvasive tests to improve their positive predictive value and increase our confidence in the diagnosis. I think we need to get to a point also where we replace liver biopsy in clinical trials with noninvasive tests, because now we realize that many of them have prognostic value.

Combination therapy, I think, will be the way to go for patients with F3 fibrosis and patients with cirrhosis. We have very promising new agents now, including a class of medications called FGF21—fibroblast growth factor 21—where we've seen very positive results on fibrosis improvement in up to 75% of patients after 2 years of treatment. And then recently, we also saw promising data on the reversal of cirrhosis, so patients going from stage IV fibrosis to stage III after 96 weeks of treatment with a new agent called 

, and we have several FGF21 agonists in development including 

We also have many incretins that are being developed, so similar to semaglutide, the GLP-1 [glucagon-like peptide 1] receptor agonist. We have new medications that target GLP-1, but we also have dual agonists that target GLP-1 and GIP [gastric inhibitory polypeptide], dual agonists that target GLP-1 and glucagon, and we have triple agonists that target all 3: GLP-1, GIP, and glucagon. And these medications are associated with significant weight loss, typically, and some of them can decrease hemoglobin A

, improve diabetes control, and they have a positive effect on dyslipidemia.

We have other oral medications that target a pathway called de novo lipogenesis, and they target lipid synthesis in the liver. And these medications might be coming before the end of this decade.

I suspect that for patients with advanced disease, we will potentially use combination therapy to make sure that we take them away from the edge of the cliff, and then maybe we can deescalate therapy and maintain them on monotherapy. But I think the future is looking better than ever for our patients with MASH, even those with cirrhosis. I'm fully confident that by the end of this decade, we will have several medications to choose from, and we will have the first medicine to treat MASH cirrhosis.

The future of treating metabolic dysfunction–associated steatohepatitis (MASH) looks brighter than ever, says Naim Alkhouri, MD, as data emerges on newly developed interventions. 

Increased Awareness, Novel Interventions Spell New Era for MASLD/MASH: Naim Alkhouri, MD

New Hope and Persistent Challenges in the MASH Treatment Landscape: Naim Alkhouri, MD

Over the past decade, the treatment landscape for metabolic dysfunction-associated steatotic liver disease (MASLD) and 

 (MASH) has undergone significant transformation, explained Naim Alkhouri, MD, FAASLD, DABOM, chief medical officer, chief of transplant hepatology, and director of the Steatotic Liver Program at Arizona Liver Health. The recent approval of resmetirom (Rezdiffra) for noncirrhotic MASH has marked a major advancement in disease management. However, addressing the needs of patients with severely cirrhotic MASH remains a key challenge that clinicians are now aiming to overcome.

In the first installment of his interview with 

, Alkhouri discussed recent advances in MASH research, the potential of both emerging and FDA-approved treatments, and the clinical challenges researchers may face as they work to further progress in the field.

What would you say are the most pressing scientific or clinical challenges related to MASH that researchers are grappling with today?

We've made a lot of progress in terms of developing new therapeutics for MASLD and MASH over the last decade. We have now 1 FDA-approved medication called resmetirom, and we are anticipating the FDA approval of semaglutide at the end of this year.

However, we have many unmet needs in the field, including treatment of patients with mass cirrhosis, this is stage four fibrosis. We are developing several therapeutics for this patient population. They have the highest disease burden on the highest chances of developing clinical outcomes. We are also trying to validate noninvasive tests that can diagnose the disease stage, monitor treatment response, and also predict long-term prognosis. We've made a lot of advancements in this area. We call it NITs, noninvasive tests, but we still need to finesse these NITs and tackle some issues related to the positive predictive value and make sure that we identify the proper patients for treatment.

We also have issues with the efficacy of the current medications. They are helpful. They lead to mass resolution and fibrosis improvement, but the delta improvement from placebo is relatively small, and we can definitely improve on it. Now we are looking at maybe a delta between 20%-30% range on MASG resolution; and for fibrosis improvement, it's between 10%-15%. I think with combination therapy and potentially neurotherapeutic agents we can improve that response rate.

Recent advances have marked a turning point for the treatment noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), with more therapies on the horizon to hopefully better address patients' cirrhosis, explained Naim Alkhouri, MD. 

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