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Liver fibrosis stage determines which GLP‑1 is FDA-indicated and most effective. Wegovy received the first formal MASH approval in August 2025 for F2-F3. Pick your stage to see ranked options.
August 2025: First FDA-approved GLP-1 for MASH
Wegovy 2.4mg accelerated approval (Aug 15, 2025) for F2-F3 non-cirrhotic MASH, based on the ESSENCE trial: 37% achieved ≥1 stage fibrosis improvement vs 22% on placebo over 72 weeks. Tirzepatide's Phase 2 SYNERGY-NASH read out in June 2024; its Phase 3 SYNERGY-OUTCOMES trial is still running.
Select your fibrosis stage
Not sure of your stage? FibroScan or transient elastography report from your hepatologist gives F0-F4. MRI elastography is most accurate. Liver biopsy is the gold standard.
Bridging fibrosis. The first FDA-indicated stage for Wegovy MASH treatment (accelerated approval, Aug 2025). Annual liver biopsy or FibroScan monitoring required.
FDA status: Wegovy 2.4mg FDA-approved for F2-F3 non-cirrhotic MASH (accelerated approval Aug 15, 2025, based on ESSENCE trial). Primary endpoint: fibrosis improvement ≥1 stage without MASH worsening.
F2 is the first formally-indicated MASH stage for GLP-1 treatment. Wegovy is the labeled choice.
FDA-indicated for F2 MASH (Aug 2025). ESSENCE trial: 37% achieved ≥1 stage fibrosis improvement vs 22% placebo.
Off-label but increasingly used for F2 MASH given higher weight-loss efficacy.
Caveat: No MASH indication until the Phase 3 SYNERGY-OUTCOMES trial reads out. Until then, Wegovy is the labeled choice.
Orforglipron — an oral small-molecule GLP-1 (single pathway, not the dual GIP/GLP-1 of Zepbound). Useful if injection avoidance is the priority; efficacy is lower than injectables.
Caveat: No MASH-specific data yet — Apr 2026 launch.
MASH (metabolic dysfunction-associated steatohepatitis) is the inflammatory form of fatty liver disease — previously called NASH. The broader category MASLD (formerly NAFLD) includes simple steatosis without inflammation. MASH carries the fibrosis progression risk.
Wegovy 2.4mg received FDA approval for F2-F3 non-cirrhotic MASH in August 2025 (accelerated approval), based on the ESSENCE trial. This is the first GLP-1 indication specifically for liver disease. Other GLP-1s show benefit but aren't formally indicated yet.
FibroScan (transient elastography) is the most common non-invasive test — your hepatologist or gastroenterologist orders it. MRI elastography is more accurate but expensive. Liver biopsy remains the gold standard but is invasive. Many primary care clinicians can interpret a FibroScan result.
Yes — ESSENCE trial showed 37% of patients on Wegovy achieved ≥1 stage fibrosis improvement vs 22% on placebo, over 72 weeks. Earlier stages (F1-F2) show higher reversal rates than later (F3).
F4 cirrhosis was excluded from major GLP-1 trials. Decompensated cirrhosis (Child-Pugh B/C) is generally a contraindication. Compensated cirrhosis (Child-Pugh A) may allow GLP-1 use under hepatology specialist management, but this is highly individualized.
Staging guidance reflects ESSENCE trial data + AASLD 2024 MASH treatment guidelines. Always coordinate GLP-1 initiation with your hepatologist or gastroenterologist if you have F2+ fibrosis.
Wegovy review →·GLP-1 by kidney function (CKD)·Our methodology