Advances in MASLD Management: From Lifestyle Intervention to Pharmacotherapy

Abstract

Metabolic dysfunction–associated steatotic liver disease (MASLD), previously called nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide. MASLD is strongly associated with obesity, type 2 diabetes and metabolic syndrome and is not only a liver disease but also a multisystem condition that affects other organs, particularly the heart and kidneys. Despite its growing burden, treatment options are still limited. Till date, Resmetirom (in 2024) and semaglutide (in 2025) are conditionally FDA-approved medications for the treatment of adults with MASH and moderate to advanced fibrosis. Therefore, lifestyle changes-such as healthy diet, regular exercise and behavior modification-remain the main and first-line treatment. Recently, there has been progress in drug development. New medicines are targeting different disease mechanisms like insulin resistance, fat toxicity, bile acid pathways, inflammation, and fibrosis. Among these, GLP-1 receptor agonists, SGLT2 inhibitors and PPAR agonists have shown promising results. This review summarizes the current management of MASLD, focusing mainly on drug therapy and lifestyle changes and advanced treatments. It also highlights important clinical trials, guidelines and future treatment strategies.