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General Endocrinology

SAT-838 - Impact of GLP-1 Receptor Agonists on Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by hepatic fat accumulation ≥5% in patients with at least one metabolic risk factor, in the absence of other causes and with minimal or no alcohol consumption. Despite its high prevalence and potential progression to advanced liver disease, pharmacological options remain limited. In this context, GLP-1 receptor agonists have demonstrated metabolic and hepatic benefits; however, their direct effects on MASLD, particularly histological outcomes, remain incompletely understood.

Objective: To evaluate the impact of GLP-1 receptor agonists on hepatic (enzymes, steatosis, fibrosis) and metabolic outcomes in patients with MASLD.

Methods: This systematic review was conducted according to PRISMA guidelines. Searches were performed in PubMed, Embase, and Cochrane Library. Two independent reviewers conducted study selection. Pediatric studies, those without relevant hepatic outcomes, and studies involving dual/triple receptor agonists were excluded. A total of 730 studies were identified; after removal of duplicates (n=285), screening, and eligibility assessment, nine randomized controlled trials were included in the final analysis.

Results: Weight reduction was consistently greater in intervention groups, ranging from −5% to −13%, compared to minimal changes in placebo groups (<−2%). Regarding hepatic biomarkers, GLP-1 receptor agonists were associated with significant reductions in alanine aminotransferase (−20% to −52%), aspartate aminotransferase (−15% to −45%), and gamma-glutamyltransferase (−20% to −50%), while control groups showed smaller or negligible changes. Metabolic outcomes also improved, with HbA1c reductions ranging from −0.5% to −1.7% in treated groups.
Histological outcomes demonstrated that semaglutide achieved resolution of steatohepatitis in up to 62.9% of patients and fibrosis reduction in 36.8%, suggesting a potential disease-modifying effect. However, no significant histological improvement was observed in patients with compensated cirrhosis. There was variability among studies regarding effect magnitude, influenced by dose, follow-up duration, and baseline characteristics.

Conclusion: GLP-1 receptor agonists are associated with significant improvements in weight loss, hepatic inflammation, and glycemic control in MASLD, with promising effects on steatohepatitis resolution and early fibrosis. However, the absence of consistent benefits in advanced liver disease and the heterogeneity among studies highlight the need for caution in interpretation. Further long-term randomized studies are required to confirm sustained histological benefits and clarify their role across different stages of disease severity.

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