Obesity treatment can reverse liver disease
February 6, 2025
Summary: Bariatric surgery can reverse even advanced metabolic liver disease and other effective obesity treatments like GLP-1 drugs are likely to do the same.
Projected metabolic related liver cancers and transplants
Source: Le, et al JAMA Network Open January 17, 2025. This is in the U.S. population.
Metabolic Associated Steatohepatitis, or MASH, doesn’t roll off the tongue, but is very common and surprisingly deadly. MASH is an inflammation of the liver that can lead to cirrhosis (liver failure) and liver cancer, and affects about 5% of the population in North America. Those with obesity, diabetes and hypertension are at higher risk for MASH. Twenty percent of those on waiting lists for liver transplantation in the U.S. have MASH.
The first drug to treat MASH, Rezdiffra (resmetirom), was approved last year and has a list price of over $48,000 annually. GLP-1 agents also appear to decrease liver inflammation in many, although this is not yet an approved indication for either semaglutide (Ozempic/Wegovy) or tirzepatide (Mounjaro/Zepbound). Novo Nordisk plans to submit an application to the FDA for Wegovy to treat MASH in the first half of 2025.
A new study in Nature Medicine shows that treating obesity effectively can decrease the liver inflammation of MASH, even if treatment is started when there is already substantial liver damage. The study demonstrated that those who had bariatric surgery were 72% less likely to suffer from a MASH related complication, including liver failure, transplantation or death. The study was small (62 who had bariatric surgery and 106 who did not), but the average observation period was long (10 years). The study was not randomized, but the controls were well matched.
Source: Aminian, et al Nature Medicine January 27, 2025. Major adverse liver outcomes are cirrhosis, transplantation, or death.
Implications for employers:
The benefits of bariatric surgery are likely higher than reported given the reversal of MASH and substantial decrease in adverse liver outcomes.
GLP-1 drugs are far more expensive over a lifetime than bariatric surgery, and early studies suggest that this treatment, too, will lower adverse liver outcomes.
The only approved MASH drug is more expensive than either bariatric surgery or GLP-1 medications. If a GLP-1 is approved for MASH and has similar impact, that will be a more cost-effective choice than Rezdiffra. Some providers might prescribe both for patients with more severe disease.