Table 3.
Evaluation of pharmacotherapies in MASLD
| Drugs | Mechanisms | Effects on MASH | Impact on Liver Fibrosis | Cardioprotective roles |
|---|---|---|---|---|
| TZDs | Activation of PPAR-γ to improve insulin sensitivity | Reduces liver fat, improves liver enzyme levels | May reduce the progression of fibrosis | Improves IR, lowers CV risk |
| GLP-1 Receptor Agonists | Promotes insulin secretion, suppresses appetite | Significantly reduces weight, improves liver function indicators | Promotes liver cell regeneration, reduces the risk of fibrosis | Has cardiovascular protective effects, lowers the incidence of cardiac events |
| SGLT-2 Inhibitors | Inhibits renal glucose reabsorption, promotes glucosuria | Reduces blood glucose, improves body weight | Reduces liver fat accumulation, may reduce fibrosis | Reduces the risk of heart failure, improves cardiac function |
| Vitamin E | Antioxidant effect, reduces oxidative stress | Improves hepatitis and liver fat content | Helps alleviate liver fibrosis | May improve overall metabolic status |
| OCA | Activates FXR, improves bile acid metabolism, anti-fibrotic | May improve liver fat content | Significantly inhibits the progression of fibrosis | Studies show potential cardiovascular benefits |
| Resmetirom | Selectively activates thyroid hormone receptor β, regulates lipid metabolism | Significantly reduces liver fat and inflammation markers | May reduce fibrosis, improve liver function | May have cardioprotective effects |
| Survodutide/ Tirzepatide | Dual GLP-1 and GIP receptor agonist, promotes weight loss | Significantly reduces weight, improves liver function indicators | May reduce liver fat and fibrosis | May improve cardiovascular health, lower cardiac risk |
| Pegozafermin | Promotes fat metabolism and anti-inflammatory effects, inhibits liver fibrosis | Improves liver fat accumulation, significantly reduces liver function abnormal indicators | Significantly inhibits the progression of fibrosis | May have a positive effect on cardiovascular health |
TZDs: thiazolidinediones, PPAR-γ: peroxisome proliferator-activated receptor gamma, IR: insulin resistance, CV risk: cardiovascular risk, GLP-1: glucagon-like peptide-1, MASH: metabolic dysfunction-associated steatohepatitis, SGLT-2: sodium-glucose transporter 2, OCA: obeticholic acid, FXR: farnesoid X receptor, GIP: glucose- dependent insulinotropic polypeptide