What is new in MASLD research 2026?

The first annual Paris International Liver Meeting (PILM), held from January 19 to 21, 2026 in Paris, brought together more than 700 hepatology professionals from 67 countries to discuss how the field is evolving from disease characterization toward precision- and mechanism-driven care ¹. Nowhere is this shift more visible than in metabolic dysfunction-associated steatotic liver disease (MASLD).

MASLD now affects an estimated 38% of the world's population, more than three billion people, and has become the second most common indication for liver transplantation in both Europe and the United States. Its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), affects 5–7% of the general population but nearly 70% of people with type 2 diabetes ⁵. What became clear at PILM 2026 is that MASLD is best understood not as an isolated liver disease, but as part of a broader cardiovascular-kidney-liver-metabolic (CKLM) syndrome, in which liver, heart, and kidney risks arise together and should be treated together.

Non-invasive tests (NITs) are also changing role. While fibrosis staging tools such as FIB-4 and vibration-controlled transient elastography (VCTE) were previously used mainly to classify disease severity, these tests are increasingly being used to predict long-term outcomes, guide who needs specialist referral, and monitor whether a given treatment is working, for example a 30% or greater reduction in liver stiffness or a 0.5-point or greater decline in the Enhanced Liver Fibrosis (ELF) score during therapy ¹.

On the treatment side, MASH has moved from a disease with no approved therapy to one with two disease-modifying medications and a large pipeline behind them. Resmetirom, a liver-selective thyroid hormone receptor-beta agonist, achieved MASH resolution without worsening of fibrosis in 25.9% of patients versus 9.7% on placebo, and fibrosis improvement in 24.2% versus 14.2%, in the pivotal MAESTRO-NASH trial ². Semaglutide, a GLP-1 receptor agonist already established in diabetes and obesity treatment, achieved MASH resolution in 62.9% of patients versus 34.3% on placebo, with fibrosis improvement in 36.8% versus 22.4%, in the ESSENCE trial ³. The two drugs work through different mechanisms — direct hepatic metabolic effects for resmetirom, and systemic insulin sensitivity and appetite regulation for semaglutide — and in the absence of head-to-head trials, treatment choice is currently guided by individual patient factors such as fibrosis stage, cardiometabolic comorbidities, and preference, rather than by a single preferred agent.

Behind these two approved options stands one of the most active drug development programs in chronic liver disease, with roughly 55 agents in phase 2-3 testing. FGF-21 analogues such as efruxifermin, pegozafermin, and efimosfermin have shown fibrosis improvement even in patients with compensated cirrhosis, raising the possibility that advanced fibrosis, long considered largely irreversible, can regress with the right therapy. Dual and triple incretin agonists are also advancing rapidly: tirzepatide, a dual GIP/GLP-1 receptor agonist, achieved MASH resolution in about 62% of patients and fibrosis improvement in more than half, alongside 15.6% weight loss, in phase 2b trials ⁴. Combination strategies pairing GLP-1 agonists with THR-beta or PPAR agonists, or jointly targeting complementary pathways such as ACC and DGAT2, are emerging as the likely future standard of care.

None of this replaces lifestyle change, which experts at PILM 2026 described as foundational, working synergistically with, not merely ahead of, pharmacotherapy. A Mediterranean or EAT-Lancet-like eating pattern, at least 150 minutes of moderate-intensity activity per week, and limiting ultra-processed foods remain central recommendations for practically all patients with MASLD. The meeting also highlighted growing recognition of MetALD, a distinct and likely underdiagnosed entity in which metabolic dysfunction and moderate alcohol use together substantially raise the risk of cirrhosis and mortality compared with MASLD alone — a reminder that assessing alcohol use belongs in every MASLD work-up, not only in patients with alcohol-related liver disease ¹.

Taken together, the data presented in Paris describe a field in transition: from a single liver-fat diagnosis to systemic cardiometabolic risk assessment, from a wait-and-see posture to active, evidence-based pharmacotherapy, and from a fixed prognosis to a genuine prospect, for at least some patients, of measurable fibrosis regression.