Semaglutide for Masld
Verdict: Published with Warning
Across 5 PubMed studies, the evidence for Semaglutide in Masld grades Tier A — moderate evidence. Effective, but with safety or population caveats.
A 🔵 A Moderate Evidence Published with Warning
Why this grade7-layer evidence engine
⚖️
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.72
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C
B
A
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← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
A · Published with Warning
Confidence
88%
Highly consistent evidence
Evidence level
E2
Multiple high-quality MAs (≥2 independent, consistent)
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.722
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (3 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 1 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (5)L2 · primary research & systematic reviews
Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis
Finding: Pivotal ESSENCE trial: once-weekly semaglutide 2.4 mg achieved MASH resolution in 62.9% vs 34.3% placebo (+28.7 pp, 95% CI 21.1-36.2, P<0.001) and fibrosis improvement in 36.8% vs 22.4% (+14.4 pp, 95% CI 7.5-21.3, P<0.001).
View on PubMed Glucagon-Like Peptide-1 Receptor Agonists Improve MASH and Liver Fibrosis: A Meta-Analysis of Randomised Controlled Trials
Finding: Across 13 RCTs (1,811 participants), GLP-1RAs increased MASH resolution (pooled OR 3.48, 95% CI 2.69-4.51, I2=0%) and fibrosis improvement (OR 1.79, 95% CI 1.37-2.35, I2=0%), with semaglutide 2.4 mg/week showing the strongest effect over placebo.
View on PubMed The impact of semaglutide on liver outcomes in patients with or at risk of MASH: a dose and duration response meta-analysis of randomized trials
Finding: Semaglutide significantly improved MASH resolution (RR 1.98, 95% CI 1.57-2.50) but did NOT significantly improve fibrosis regression (RR 1.18, 95% CI 0.74-1.88); it also reduced steatosis, ELF score, ALT/AST, and all-cause mortality (RR 0.82, 95% CI 0.74-0.91), with larger effects at higher dose and longer duration.
View on PubMed Meta-analysis of clinically available pharmacotherapy of biopsy confirmed metabolic dysfunction associated steatohepatitis (MASH)
Finding: Across 14 publications (3,173 biopsy-confirmed MASH subjects), resmetirom, semaglutide, tirzepatide and dapagliflozin all significantly improved resolution and fibrosis-without-steatohepatitis-worsening rates (all p<0.015), but no isolated semaglutide-specific effect estimate was reported.
View on PubMed Semaglutide 2.4 mg in Participants With Metabolic Dysfunction-Associated Steatohepatitis: Baseline Characteristics and Design of the Phase 3 ESSENCE Trial
Finding: Design/baseline-characteristics paper for the ESSENCE phase 3 trial: of 800 baseline participants, 31.3% had fibrosis stage F2 and 68.8% had stage F3; this paper reports no treatment effect (results are in PMID 40305708).
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Supportive
The U.S. Food and Drug Administration approved a new indication for use for Wegovy (semaglutide) injection to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. Wegovy should be used in addition to a reduced calorie diet and increased physical activity. Wegovy is the first weight loss medication to also be app… source↗
L4b EU EFSA
Supportive
Wegovy: Authorised - This medicine is authorised for use in the European Union. Marketing authorisation date: 06 January 2022. The medicine can only be obtained with a prescription. Wegovy is used together with diet and physical activity to manage weight (including losing weight and keeping it off) in adults with a body mass index (BMI) of 30 kg/m2 or more (obesity) or in adults with a BMI of a… source↗
L4c UK NHS
Supportive
Semaglutide is recommended as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and increased physical activity in adults, only if: it is used for a maximum of 2 years, and within a specialist weight management service providing multidisciplinary management of overweight or obesity (including but not limited to tiers 3 and 4), and th… source↗
L4d TW TFDA / 衛福部
Supportive
胰妥讚 注射劑 Ozempic solution for injection 衛部菌疫輸字第001107 號；主成分 Semaglutide 1.34mg/mL,3mL；適應症：用於第二型糖尿病成人病人作為飲食和運動之輔助療法，以單一療法或與其他糖尿病治療藥品併用方式，治療控制不佳之第二型糖尿病；對於第二型糖尿病合併已確診心血管疾病之病人，可降低主要不良心血管事件之風險。健保給付規定：限第二型糖尿病病人經 metformin 及/或 sulfonylurea 兩類藥品最大耐受劑量，及繼續使用下列藥品其中之一達 6 個月後 HbA1c 仍 ≥8.5% 者使用。 source↗
L4e WHO
Supportive
GLP-1 therapies may be used by adults, but excluding pregnant women, for the long-term treatment of obesity. [...] GLP-1 receptor agonists – semaglutide, dulaglutide and liraglutide [added to EML] for adults with type 2 diabetes mellitus with established cardiovascular disease or chronic kidney disease and obesity (defined as body mass index (BMI) ≥ 30kg/m2). [...] High prices of medicines like… source↗
L5a NIH Office of Dietary Supplements
Supportive
Semaglutide (Ozempic, Wegovy, Rybelsus) is a prescription GLP-1 medication used for weight loss and weight management, type 2 diabetes treatment, or to reduce the risk of chronic kidney disease and major cardiovascular events in certain patients with type 2 diabetes. Semaglutide (Wegovy) is also used to treat metabolic dysfunction-associated steatohepatitis (MASH), without cirrhosis of the live… source↗
L5b Mayo Clinic
Supportive
In August 2025, the Food and Drug Administration (FDA) conditionally approved the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Ozempic, Wegovy) for the treatment of MASH and moderate to advanced fibrosis. The primary treatments are lifestyle based: losing weight, eating a healthy diet and getting regular exercise, which can reduce the amount of fat in the liver, with the added … source↗
L5c Cleveland Clinic
Supportive
These drugs reduce inflammation and fat in your liver. Examples are liraglutide (Victoza®, Saxenda®) semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®, Zepbound®). source↗
L5d Harvard Health
Supportive
More research is needed, but the findings suggest that semaglutide and, perhaps other GLP-1 agonists, hold promise for helping people with MASH. source↗
L5e Specialty Society (condition-mapped)
Supportive
the U.S. Food and Drug Administration's (FDA) recent approval of Wegovy(R), widely recognized for weight loss and diabetes management, as a new treatment for adults with Metabolic dysfunction-Associated Steatohepatitis (MASH) and moderate to advanced liver fibrosis. Wegovy is now the first FDA-approved GLP-1 therapy specifically for treating MASH. ... The recommendations reflect the latest clin… source↗