Treatment of MASLD in Compensated MASH-Related Cirrhosis
Adults with metabolic dysfunction-associated steatotic liver disease (MASLD) who have progressed to MASH-related cirrhosis in the compensated stage represent a clinically distinct population. Established cirrhosis substantially alters the applicable management options compared with earlier phases of the disease.
Clinical Setting: Compensated MASH-Related Cirrhosis
This protocol applies specifically to patients with compensated cirrhosis arising from metabolic dysfunction-associated steatohepatitis (MASH) — a stage at which liver synthetic function is broadly preserved, yet the structural disease imposes important constraints on which therapeutic interventions can safely be used.
Management Approach
No MASH-targeted pharmacotherapy is currently recommended at the cirrhotic stage. The approach centres on nutritional optimisation and on the careful adaptation of metabolic therapies to the patient's preserved liver function class and individual risk profile; additional targeted considerations apply when clinically significant portal hypertension is present.
References
DOI: 10.1016/j.jhep.2024.04.031
- No MASH-targeted pharmacotherapy can currently be recommended for adults with MASH at the cirrhotic stage (LoE 5, weak recommendation, strong consensus).
- Moderate weight reduction can be suggested in adults with compensated cirrhosis and obesity, with an emphasis on high protein intake and physical activity to maintain muscle mass and reduce the risk of sarcopenia (LoE 3, weak recommendation, strong consensus).
- If CSPH is present, non-selective beta-blockers may be started unless contraindicated (LoE 3, weak recommendation, strong consensus).