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Lookup NU author(s): Dr Kate HallsworthORCiD, Professor Quentin AnsteeORCiD, Dr Leah Avery, Helen Jarvis, Dr Dina Mansour, Professor Stuart McPhersonORCiD
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© 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Metabolic dysfunction-associated steatohepatitis (MASH), a potentially progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), increases risk of fibrosis progression, cirrhosis, and liver-related and cardiometabolic morbidity. The first licensed pharmacotherapies, resmetirom and semaglutide, mark a shift in management but practical guidance for real-world implementation is lacking. The British Association for the Study of the Liver and British Society of Gastroenterology MASLD special interest group developed consensus recommendations on patient selection, lifestyle management, and follow-up for MASLD–MASH-specific pharmacotherapy. 37 participants participated in a Delphi process where draft statements developed in working groups were anonymously rated, discussed, and refined. Consensus (≥80% agreement) was reached for 49 statements. The group agreed on the following general recommendation. Two-step non-invasive tests, including the Fibrosis-4 index and vibration-controlled transient elastography, are recommended to identify patients with presumed stage F2–F3 fibrosis (ie, at-risk MASH). Individuals with liver stiffness more than 10 kPa but without evidence of cirrhosis should be considered eligible for treatment. Lifestyle behaviour change intervention should accompany pharmacological treatment, delivered by suitably trained practitioners without delaying access to medication. Treatment discontinuation is advised with evidence of disease progression, cirrhosis development, or drug-induced liver injury. These recommendations offer pragmatic guidance to clinicians and consensus clinical opinion to regulatory bodies to support equitable and effective use of new MASLD–MASH therapies.
Author(s): Cobbold JF, Miller H, Hallsworth K, Manousou P, Marjot T, Allison MED, Anstee QM, Armstrong MJ, Avery L, Azzu V, Brennan PN, Byrne CD, Cacciottolo TM, Corless L, Forton D, Hardy T, Hebditch V, Jarvis H, Li W, Mansour D, McPherson S, Miao Y, Morling J, Mukhopadhya A, Mullish B, Parker R, Patanwala I, Patel J, Pavlides M, Reinson T, Rowe IA, Saffioti F, Shaikh F, Srivastava A, Than NN, Tsochatzis E, Volcek E, Tomlinson JW, Alazawi W
Publication type: Review
Publication status: Published
Journal: The Lancet Gastroenterology and Hepatology
Year: 2026
Volume: 11
Issue: 7
Pages: 616-626
Print publication date: 01/07/2026
Online publication date: 30/04/2026
Acceptance date: 02/04/2018
ISSN (print): 2468-1253
ISSN (electronic): 2468-1156
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/S2468-1253(26)00077-4
DOI: 10.1016/S2468-1253(26)00077-4
PubMed id: 42070581
