Future investigational therapies for MASH include tirzepatide and other dual- or triple-incretin receptor agonists, gliflozins, pan-peroxisome proliferator-activated receptor agonists such as lanifibranor, fibroblast growth factor 21 analogs, fatty acid synthase inhibitors, and genetic target-based therapies such as antisense oligonucleotides targeting PNPLA3.^[1]

Blood-based biomarkers of fibrosis and vibration-controlled transient elastography are expected to be used more frequently to monitor disease progression and regression, predict long-term liver-related events, and assess treatment response. Polygenic risk scores, metabolic signatures, and microbiome signatures may help identify patients with distinct MASLD trajectories and treatment responses.