Key Takeaways:

• A pharmacist (PharmD)-led sub-clinic increased access to glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide, among patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
• Treatment approval and initiation occurred rapidly among study participants, with maximum doses being achieved within a median of 119 days.
• While only a small number of patients achieved the primary outcome of at least 10% weight loss, nearly half of the participants experienced meaningful weight reductions.

A poster presented at AASLD TLM 2026 demonstrated the impact of a PharmD-led sub-clinic on real-world health outcomes among patients with MASLD.

The goal of the sub-clinic was to expand patient access to GLP-1 RAs, particularly semaglutide. Clinicians focused on treatment initiation, dose escalation, and patient monitoring.

Study Methods and Outcomes

The retrospective cohort study included 118 patients with MASLD who were referred to a PharmD-led sub-clinic between January 2022 and March 2024.

The primary outcome was a weight loss reduction of at least 10% within 12 months of semaglutide initiation. Secondary outcomes included changes in elastography parameters, glycemic indices, treatment adherence, and medication tolerance.

Patient Characteristics

The average body mass index among study participants was 35.6 kg/m. Comorbidities were present in most patients, with 40.7% having diabetes and 66.9% having dyslipidemia. Nearly 15% of patients had advanced fibrosis (F4).

Semaglutide Access, Efficacy, and Safety

All patients involved in the PharmD sub-clinic received insurance approval for semaglutide, with a median of 5 days for treatment initiation. Patients reached maximum dosage within a median of 119 days, with 42.4% achieving doses of at least 2 mg per week.

Weight reductions were lower than expected, with only 20% of patients losing 10% or more of their body weight. Most reductions were below the 10% threshold, with 41% of patients achieving a weight loss of at least 5%, and 31% achieving a weight loss of at least 7%. After 1 year of semaglutide therapy, the median weight loss was 8%.

Only 22 patients had paired elastography data, with median decreases of 1.0 kPa and 31 dB/m in liver stiffness and controlled attenuation parameter, respectively.

Adverse events were frequent, and the most common symptom was nausea, which occurred among 44.9% of patients. Nearly one fourth (21%) of patients discontinued the study due to treatment intolerance.

Implications for Managed Care

These findings indicate the potential of PharmD-led sub-clinics in expanding GLP-1 RA access and accelerating treatment initiation among patients with MASLD.

The study also establishes the efficacy of semaglutide, with patients experiencing meaningful improvements in weight loss, steatosis, liver stiffness, and cardiometabolic parameters.

The authors said, “Although weight loss outcomes were lower than those reported in randomized trials, likely reflecting real-world barriers including medication supply limitations, copay burden, and less intensive lifestyle supervision, this multidisciplinary model represents a scalable strategy to improve MASLD care delivery.”

Reference

Nguyen N, Kohen E, Gozar M, Satapathy S. Assessing the effect of semaglutide in patients with MASLD: real-world experience from a pharmacist-led sub-clinic. Hepatology. 2026;84(S1):2082. doi:10.1097/HEP.0000000000001842. Abstract presented at: AASLD The Liver Meeting 2026; November 5-9, 2026; Denver, CO.