Zobair Younossi, MD, on Global Consensus Recommendations for MASLD/MASH
Dr Younossi reviews key points from the recent update of global consensus recommendations for diagnosis and management of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic associated steatohepatitis (MASH).
Zobair Younossi, MD, is chairman of the Global NASH/MASH Council and Professor of Medicine and Chairman of the Global Center for Liver Outcomes and Policy Research at Georgetown University School of Medicine in Washington, DC.
Clinical Practice Summary
Global Consensus Recommendations Update for MASLD/MASH Management
- MASLD/MASH | Global NASH/MASH Council | Clinical Gastroenterology and Hepatology: Updated global consensus recommendations, initiated in 2024 and developed through a systematic literature review and Delphi process involving ~290 experts from ~65 countries, have been accepted for publication.
- Resmetirom; Semaglutide | Risk stratification: The updated algorithm incorporates resmetirom and semaglutide and recommends FIB-4 as the primary first-line noninvasive test, followed by VCTE or, if unavailable, the Enhanced Liver Fibrosis (ELF) blood test.
- Clinical practice: The recommendations provide thresholds for second-line noninvasive tests after FIB-4 to guide treatment selection and outline use of serial second-line test changes to monitor treatment response, with planned ongoing updates as new evidence emerges.
TRANSCRIPT
Hello, I'm Zobair Younossi. I'm chairman of the Global NASH MASH Council, as well as Professor of Medicine and Chairman of Global Center for Liver Outcomes and Policy Research at Georgetown University School of Medicine. I'm delighted to be here with you to talk about our recent publication in Clinical Gastroenterology and Hepatology that has to do with global consensus recommendation related to MASLD treatment, risk stratification, and other clinical aspects.
This project actually initially started in 2024. At the time, there were no treatments for MASLD or MASH. And even in terms of risk stratification and use of noninvasive test or NITs, there were some discrepancies in terms of what labs or what tests to use and what thresholds to actually use for risk stratification. Having the access for our collaboration through the Global NASH/MASH Council, which is a global collaboration of about 290 experts from about 65 different countries across the globe, we created a group of leaders that came together to develop a consensus through a very systematic approach of looking at the literature and then developing Delphi process to come to consensus.
Our first round of this assessment was published in gastroenterology in fall of 2025. And of course, at the time we already had one drug approved, which was resmetirom. Now, our premise behind doing this consensus recommendation was number one, to see if we have some agreement on where there is actually some discrepant, at least, recommendations by different guidelines for MASLD.
Second, we wanted to make sure that the document we put together is simple to understand. There are a lot of graphics that people can use and also limit our noninvasive tests to the ones that we think probably will be most used in the clinical setting. And these are basically the most common, first-line noninvasive test being FIB-4. And the most common second-line test for the stratification is VCTE or vibration-controlled transient elastography. But if you don't have access to transient elastography, then you could use an enhanced level fibrosis, which is a blood test or ALT test.
Our last premise behind doing this project was to make sure that this is a live document and that we update this document from time to time. Since the time that the document was published in Gastroenterology, we have had another drug that's approved and more data on the noninvasive tests, which prompted us to do another set of this consensus development with another group of experts, international experts, going again through the literature, and now creating an algorithm that not only will use the two drugs that are available, resmetirom and semaglutide, but also use the noninvasive tests that is probably a little bit more data, not in terms of what level, what threshold do you use for VCTE or for ALF tests after you've done a FIB-4 to select the patient for treatment, but also how to monitor patients using changes in these second-line noninvasive tests to determine if a patient responding to treatment or is not responding to treatment.
The summary of this second revision of our consensus guideline is now accepted and it's an early review as accepted article at the Clinical Gastroenterology and Hepatology, which is the other journal for the American Gastroenterological Association. Our intention is to continue to look at the field and continue to update these consensus recommendations through the same very robust methodology that we are using so that we can ultimately help clinicians in terms of management of these patients in a relatively easy to use and in practical ways that can be adopted easily in clinical practice
