The Paris International Liver Meeting (January 19-21, 2026) brought together leading hepatology experts to discuss transformative advances in chronic liver disease management. The meeting highlighted pivotal developments reflecting the field's evolution from disease characterisation toward precision, mechanism-based therapeutics. Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), were highlighted, marking the transition to an era of approved disease-modifying therapies. Resmetirom and semaglutide are now approved for MASH with F2-F3 fibrosis, with a robust pipeline generating anti-fibrotic signals through FGF21 analogs, pan-peroxisome proliferator-activated receptor (PPAR) agonists, and incretin-based dual and triple agonists. Non-invasive tests have evolved beyond their original diagnostic role to enable prognostic stratification, screening of at-risk populations, treatment selection, and monitoring of therapeutic response. This evolution is not limited to MASLD, but extends to other chronic liver diseases, including primary biliary cholangitis (PBC) and portal hypertension, as highlighted by the recommendations of the Baveno Consensus Workshops. Hepatitis B and D are moving toward functional cure strategies, with simplified HBV treatment algorithms based on fibrosis and viral load, supported by biomarkers for risk stratification and safe treatment discontinuation. In parallel, HDV management is transitioning from a severe disease to one with emerging suppressive and potential curative l through bulevirtide and novel HBsAg-targeting and RNA-silencing therapies, respectively. Management of PBC has advanced with novel PPAR agonists that improve cholestatic biochemistry and pruritus, supported by individualised risk stratification. However, significant treatment gaps persist, with fewer than half of eligible PBC patients receiving second-line therapy, and fatigue remains a major unmet clinical need. Furthermore, effective pharmacotherapies for primary sclerosing cholangitis (PSC) remain a major challenge, and no approved disease-modifying treatments are currently available. Finally, for patients with hepatocellular carcinoma (HCC), immunotherapy combinations can achieve unprecedented long-term survival in selected populations of patients. Collectively, these advances define a new era of hepatology centered on precision medicine, earlier intervention, and mechanism-driven therapeutic strategies.
