From the Guidelines
Rybelsus (semaglutide) is not contraindicated in MAFLD (Metabolic Associated Fatty Liver Disease) and can be used for its approved indications, such as type 2 diabetes and obesity, as it improves cardiometabolic outcomes. According to the latest clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) 1, glucagon-like peptide 1 receptor agonists (GLP1RAs), including semaglutide, are safe to use in MASH (including compensated cirrhosis) and should be used for their respective indications. The guidelines state that GLP1RAs cannot currently be recommended as MASH-targeted therapies due to the lack of robust demonstration of histological efficacy on steatohepatitis and liver fibrosis in large phase III trials 1. However, they can be used for their approved indications, and their use improves cardiometabolic outcomes, which is beneficial for patients with MAFLD.
The medication works as a GLP-1 receptor agonist, which helps improve insulin sensitivity, reduce appetite, and promote weight loss—all factors that can positively impact liver health in MAFLD patients. Some key points to consider when using Rybelsus in patients with MAFLD include:
- Starting with a standard oral dose of 3 mg once daily for 30 days, then increasing to 7 mg once daily, with a possible further increase to 14 mg daily if needed for glycemic control
- Taking the medication at least 30 minutes before the first food, beverage, or other oral medications of the day, with no more than 4 ounces of plain water
- Monitoring patients for gastrointestinal side effects, which are common with GLP-1 receptor agonists
- Using the medication with caution in those with a history of pancreatitis or severe gastrointestinal disease
Overall, Rybelsus can be a valuable treatment option for patients with MAFLD, particularly those with concurrent type 2 diabetes, obesity, or insulin resistance, as it can help improve glycemic control, promote weight loss, and reduce the risk of cardiovascular complications 1.
From the Research
Rybelsus (Semaglutide) and MAFLD
- Rybelsus (semaglutide) is not contraindicated in MAFLD (Metabolic Associated Fatty Liver Disease) 2, 3, 4.
- In fact, studies suggest that semaglutide may have a beneficial effect on liver steatosis and fibrosis in patients with MAFLD 3, 4.
- A meta-analysis found that semaglutide improved alanine aminotransferase (ALT) levels, liver stiffness, and steatosis in patients with MAFLD 4.
- Another study found that semaglutide reduced the hepatic steatosis index (HSI) and fibrosis-4 (FIB-4) index in patients with type 2 diabetes and MAFLD 3.
Comparison with Other Treatments
- Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, such as canagliflozin, have also been shown to improve liver-related outcomes in patients with MAFLD 5.
- A study found that SGLT-2 inhibitors and pioglitazone improved liver enzymes, but SGLT-2 inhibitors had a larger improvement in FIB-4 index than pioglitazone in patients with MAFLD 6.
- However, more research is needed to compare the efficacy of semaglutide with other treatments for MAFLD.
Safety and Efficacy
- Semaglutide has been shown to be safe and effective in improving glycemic control and weight loss in patients with type 2 diabetes 2, 3, 4.
- However, semaglutide may increase the risk of adverse events such as diarrhea, nausea, and vomiting 4.
- Further studies are needed to fully understand the safety and efficacy of semaglutide in patients with MAFLD.