The lancet. Gastroenterology & hepatology

Expert agreement on drug treatments for metabolic liver inflammation without advanced scarring in the UK

Updated

Abstract

Consensus was reached on 49 statements regarding the management of metabolic dysfunction-associated steatohepatitis (MASH).

  • Two-step non-invasive tests are recommended to identify patients with presumed stage F2-F3 fibrosis, indicating at-risk MASH.
  • Individuals with liver stiffness greater than 10 kPa but no evidence of cirrhosis may be eligible for treatment.
  • Lifestyle behavior change interventions should accompany pharmacological treatments, delivered by trained practitioners.
  • Treatment discontinuation is advised if there is progression of the disease, development of cirrhosis, or drug-induced liver injury.
  • These recommendations aim to provide practical guidance for clinicians and support equitable use of new therapies.

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Funding

Competing interests

Declaration of interests WA has received consultancy or speaking fees or travel funds from 89Bio, Akero, AstraZeneca, Conclusio, Echosens, Gilead Sciences, Goldman Sachs, GSK, Inventiva, Janssen, Kudu Spectrum, Liberum, Madrigal, Novo Nordisk, and UCB Biopharma; holds stock or stock options at Metadeq; and his institution has received competitive grants from Gilead, GSK, and Merck. MEDA has research collaborations with AstraZeneca and GSK. QMA reports grant funding from AstraZeneca, Boehringer Ingelheim, and Intercept; royalties from Elsevier; consulting fees on behalf of Newcastle University from AbbVie, Alimentiv, Akero, AstraZeneca, Axcella, 89Bio, Boehringer Ingelheim, Boston Pharmaceuticals, Corcept Therapeutics, Echosens, Eli Lilly, Gilead, GlaxoSmithKine, HistoIndex, Intercept, Inventiva, Madrigal, Medpace, Merck, Metadeq, Novo Nordisk, PathAI, Pfizer, Pharmanest, Prosciento, Regeneron, Resolution Therapeutics, Roche, and Terns; speaker fees from Avalere, Catalyst Medical Education, Integritas Communications, Medscape, NovoNordisk, and Springer Healthcare; and participation on a data safety monitoring board on behalf of Newcastle University for Medpace and Gilead. MJA has received consultancy fees from Norgine, Novo Nordisk, and Madrigal and speaker fees from Chiesi, Advanz, and Stanning Pharma. VA is currently an employee and shareholder of AstraZeneca. PNB has received consultancy fees from Novo Nordisk, Madrigal, and Resolution Therapeutics; speaker fees from Takeda; and travel grants from Novo Nordisk. CDB has received research grants from Echosens. TMC reports speaker fees from Madrigal. JFC has received consultancy fees from Madrigal and Novo Nordisk and speaker fees from Madrigal. SMcP has received consultancy fees from Madrigal, Novo Nordisk, Gilead, and Kent Pharma and speaker fees from Norgine and Gilead. AM has received consultancy fees from Magrigal and Ipsen and speaker fees from Gilead. LC has received consultancy fees from Madrigal and Novo Nordisk and speaker fees and travel support from Madrigal. DF has received speaker fees from Gilead and Madrigal. PM has received consultancy fees from Madrigal and Novo Nordisk and payment for expert testimony from 89Bio. RP has received consultancy fees from Boeringer Ingelheim and Orphalan and speaker fees from GSK. IP has received consultancy fees from Ipsen, Advanz Pharma, and Dr Falk and speaker fees from Ipsen and Advanz Pharma. MP is a shareholder in Perspectum. TR has received research grants from Echosens. IAR reports consultancy fees from Boehringer Ingelheim, Madrigal, and Novo Nordisk and speaker fees from Bayer Healthcare. FS reports consultancy and advisory board fees from Dr Falk Pharma. AS has received speaker fees from Intercept in the last 3 years. ET reports consultancy fees from Boehringer Ingelheim, Novo Nordisk, Madrigal, Siemens, and MSD; speaker fees from Boehringer Ingelheim, Novo Nordisk, Echosens, Gilead, AstraZeneca, and AbbVie; and participation in a data safety monitoring board for GSK. JWT reports consultancy fees from Madrigal, Rhythm Pharmaceuticals, and Novo Nordisk and speaker fees from Novo Nordisk. All other authors declare no competing interests.
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