Ozempic and Wegovy have been dominating health headlines for their dramatic impact on weight loss and type 2 diabetes. But beneath those splashy headlines is another story—one with major implications for millions living with liver disease. These drugs, both brand names for semaglutide, are now showing serious potential in the treatment of metabolic dysfunction-associated steatohepatitis (MASH), a progressive and often silent liver disease with no currently approved medication.
A quiet but growing epidemic
MASH, formerly known as non-alcoholic steatohepatitis (NASH), is part of a spectrum of conditions linked to fat accumulation in the liver. It’s closely tied to obesity, insulin resistance, and metabolic syndrome. When left untreated, it can cause liver inflammation, scarring (fibrosis), cirrhosis, and even liver cancer. You don’t have to drink a drop of alcohol to get it. And it’s more common than many people realise.
Current estimates suggest that around 5% of US adults are living with MASH, though the number could be higher due to underdiagnosis. It’s often symptomless until it’s advanced, and by then, treatment options are limited. Weight loss and lifestyle changes remain the first-line approach, but sustained weight reduction is incredibly difficult for many, especially without medical support.
That’s where semaglutide steps in.
What the latest research shows
A 2024 trial published in The New England Journal of Medicine tested semaglutide’s impact on nearly 800 people diagnosed with MASH. Over a 72-week period, more than half of the participants received weekly semaglutide injections, while the remainder were given a placebo. The findings were striking. Among those taking semaglutide, more than 60% experienced resolution of liver inflammation and a reduction in liver fat—without worsening fibrosis. Around 37% even saw an improvement in fibrosis itself, compared to just 22% in the placebo group.
While this isn’t a magic cure, the results mark a turning point. Until now, no drug has shown this level of benefit for MASH, and the fact that it happened alongside an average weight loss of over 10% makes the case even stronger. Losing that amount of body weight is linked to major metabolic improvements and a slower progression of liver damage.
How semaglutide works in the body
Semaglutide is part of a class of medications known as GLP-1 receptor agonists. These drugs mimic a naturally occurring hormone that helps regulate blood sugar, insulin production, and appetite. In practice, that means people taking semaglutide feel fuller sooner and tend to eat less overall. It also slows digestion and has a stabilising effect on blood sugar levels.
The link between these effects and liver health is becoming clearer. Weight loss alone can reduce liver fat, but semaglutide seems to do more than that. According to researchers at the Mayo Clinic, the drug may help reduce inflammation at the cellular level and improve insulin sensitivity—two key drivers in the development of MASH.
The scale of the opportunity
What makes this so promising is that semaglutide is already widely available and prescribed under the brand names Ozempic (for type 2 diabetes) and Wegovy (for obesity). In some countries, demand for the drug has even outstripped supply. But the prospect of extending its use to treat liver disease—particularly in patients who may already be dealing with obesity or diabetes—could transform the way the condition is managed.
Novo Nordisk, the manufacturer of both drugs, has already stated its intention to seek regulatory approval for this use by mid-2025. If that happens, it would mark the first-ever medication specifically approved for MASH—a milestone for patients, researchers, and doctors alike. As Reuters reports, this change could dramatically expand the reach and role of semaglutide in long-term health management.
Side effects, limits, and long-term thinking
It’s important to be realistic. Semaglutide, while effective, isn’t without its downsides. Nausea, vomiting, and gastrointestinal discomfort are common, especially in the early stages of use. Most people adjust, but some discontinue the drug for this reason.
There are also more complex concerns. For example, while rapid weight loss is usually welcomed, it can increase the risk of gallstones. The drug’s long-term impact on mental health is also being studied after reports emerged linking it to mood changes, including anxiety and depression. These side effects aren’t officially confirmed by UK health authorities, but they’ve been highlighted by patients and flagged as something to watch.
Still, the risk-benefit balance remains favourable for most people, particularly those facing serious health consequences if MASH progresses.
Where this could lead next
With the medical community shifting toward earlier and more aggressive intervention in metabolic conditions, semaglutide’s reach may soon go even further. Already, doctors are exploring its use in preventing cardiovascular disease, kidney decline, and even certain forms of cancer—all of which are linked to metabolic dysfunction. Liver disease is just one piece of the puzzle.
Crucially, semaglutide offers a tool not just for managing symptoms, but for changing the trajectory of disease. That’s what makes its potential in MASH so exciting. For years, patients have been told to simply “eat better and exercise more,” while knowing full well how hard that is without proper support. Now, they may finally have something more concrete—a treatment that doesn’t just manage the effects of liver disease but actually pushes it into remission.
What we still don’t know
There’s still a lot we don’t know. Will people need to stay on semaglutide indefinitely to keep the benefits? Will its impact on fibrosis hold up over longer studies? What happens when it’s used alongside other medications or interventions? These questions need answers.
However, even with those uncertainties, the evidence we have points to a genuine breakthrough. Not just in terms of treating MASH, but in how we approach conditions that once seemed intractable. And for the millions of people worldwide living with or at risk of liver disease—many of whom don’t even know they have it—that’s news worth paying attention to.