GLP-1 receptor agonists in metabolic dysfunction-associated steatohepatitis: a systematic review and meta-analysis of randomized controlled trials

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• Picked for Hepatology (top studies of the week, 2 August 2026).
• Picked for Histology (top studies of the week, 2 August 2026).

Abstract

BACKGROUND: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease with unmet clinical treatment needs, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) show promising therapeutic potential. This study systematically evaluated the efficacy of GLP-1 RAs in treating adult MASH patients via a meta-analysis of randomized controlled trials (RCTs). METHODS: Following PRISMA 2020 guidelines, we retrieved RCTs from PubMed, Embase, Cochrane Library and Web of Science. Eligible studies included adult MASH patients treated with GLP-1 RAs vs. placebo/standard care. Two reviewers independently performed literature screening, data extraction and risk-of-bias assessment (RoB 2.0). Meta-analysis was conducted using RevMan 5.4, with subgroup analyses by GLP-1 RA type and intervention duration. RESULTS: A total of 27 RCTs involving 2,687 patients were included. GLP-1 RAs significantly increased MASH resolution without fibrosis worsening (RR = 2.56; 95% CI, [1.90, 3.44]; p < 0.00001; I2 = 49%) and liver fibrosis improvement without steatohepatitis worsening (RR = 1.37; 95% CI, [1.06, 1.78]; p = 0.02; I2 = 44%). Subgroup analyses showed GLP-1 RAs benefited MASH resolution across subgroups, while fibrosis improvement was only significant for multi-receptor agonists and intervention > 48 weeks. No significant changes in ALT/AST were observed (p > 0.05). CONCLUSIONS: GLP-1 receptor agonists are effective for achieving histological remission in MASH. More large-scale, long-term follow-up randomized controlled trials are urgently needed. Trial registration The protocol for our meta-analysis and systematic review was registered and recorded in PROSPERO (registration no. CRD420261287573).

Abstract as published, via PubMed.