What Is the Role of GLP-1 Receptor Agonists in the Treatment of MASLD: A Narrative Review

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the hepatic manifestation of metabolic syndrome. It affects up to 38% of adults globally and has few approved pharmacological treatment options. Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve metabolic dysfunction and have shown beneficial effects in MASLD, the mechanism(s) mediating these hepatic effects, particularly the relative contributions of direct and indirect mechanisms remain incompletely understood. This review is aimed at exploring the potential role of GLP-1 RAs in MASLD treatment.

Methods

A structured search of PubMed, Embase, and Web of Science was conducted on 1st April 2026. The study findings were reported narratively and grouped by measures of liver outcomes.

Results

Forty-five studies meeting predefined inclusion criteria were identified. GLP-1 RAs—particularly semaglutide—have demonstrated beneficial effects in metabolic dysfunction-associated steatohepatitis (MASH), including reductions in liver steatosis, histological resolution of steatohepatitis, and, more recently, improvements in liver fibrosis. Evidence supports contributions from both weight-dependent and potentially weight-independent mechanisms. Dual and triple incretin receptor agonists also showed significant reduction in liver fat content and improvements in other indices of MASLD. Benefits were also seen in late-stage MASLD (cirrhosis), although these were inconsistent. There is also potential for improvements in pediatric MASLD, but current evidence is limited.