Pharmacotherapy in metabolic-dysfunction-associated steatotic liver disease: an updated review of the past, present and a promising future.

Metabolic-dysfunction-associated fatty liver disease (MAFLD) or metabolic-dysfunction-associated steatotic liver disease (MASLD) has been recognised as one of the most important aetiologies of chronic liver disease and also a marker of high risk for atherosclerotic cardiovascular disease (ASCVD) in patients with or without diabetes. The presence of diabetes accelerates the progression of MASLD. The pathogenesis of metabolic dysfunction-associated steatohepatitis (MASH) is complex and the diagnostic procedures to assess histologic endpoints in clinical trials are challenging. This poses significant difficulties in the discovery of newer drugs with meaningful efficacy. A comprehensive literature search using MEDLINE (via PubMed), Scopus and Google Scholar databases was performed to write a narrative evidence-based review on the current status of different pharmacotherapies in MASLD. Despite numerous pharmacotherapies being studied, until recently, there was no approved agent for the treatment of MASH. However, some established and few emerging medications have recently shown promising effects in preventing its progression, as evidenced in preclinical and clinical trials. This narrative review summarises the current status, mechanisms, efficacy and safety of established as well as new and emerging pharmacotherapies for treatment of MASH. It also provides a practical approach to the clinical use of these agents.