Clinical utility of a 30% reduction in VCTE-derived liver stiffness measurement for identifying histologic improvement in MASH
In brief
A 30% reduction in VCTE stiffness quadruples odds of fibrosis regression
In 160 adults with biopsy-proven MASH and stage 2-3 fibrosis, a drop of at least 30% in vibration-controlled transient elastography liver stiffness was linked to a four-fold higher chance of histologic fibrosis improvement, though the test's overall accuracy was modest (AUC ~0.65). The finding supports VCTE as a useful, but imperfect, non-invasive marker, highlighting the need for better biomarkers.
- Journal
- Hepatology (Baltimore, Md.) (Q1)
- Published
- 2 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Rohit Loomba, Ruiqiu Chen, Youxin Wang, Ricki Bettencourt, Egbert Madamba, Kaleb Tesfai, et al.
- PMID
- 42691332
- DOI
- 10.1097/HEP.0000000000001856
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 5 September 2026): VCTE liver stiffness as non‑invasive biomarker for MASH
Abstract
BACKGROUND AND AIMS: The American Association for the Study of Liver Diseases (AASLD) recommends that a decline in liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) can be used as a non-invasive endpoint for treatment response in metabolic dysfunction-associated steatohepatitis (MASH), but there are limited data supporting this statement. We examined the association between a ≥30% relative decline in LSM and fibrosis regression. APPROACH AND RESULTS: This prospective study included 160 adults (64% female) with biopsy-proven MASH and stage 2-3 fibrosis from a randomized, phase 2b, multicenter, placebo-controlled trial of the fibroblast growth factor 21 analog pegozafermin. All participants underwent contemporaneous VCTE assessments and liver biopsy at two time-points. The primary endpoint was fibrosis regression without worsening MASH. The median (IQR) age and body mass index of participants were 56.0 (49.0-62.0) years and 36.5 (32.2-40.4) kg/m². The area under the receiver operating curve (AUC) of a ≥30% relative decline in LSM by VCTE for detecting fibrosis regression was 0.68 (95% CI 0.58-0.77). In multivariable analyses adjusted for age, sex, type 2 diabetes, BMI, and ethnicity, a ≥30% relative decline in LSM was independently associated with fibrosis regression (adjusted OR 4.23, 95% CI 1.79-10.38, p=0.001). In a distinct validation cohort (n=48) from U.S. and Singapore, a ≥30% decline in LSM for detecting fibrosis regression yielded an AUC of 0.62 (95% CI 0.48-0.76). CONCLUSION: A ≥30% relative decline in LSM by VCTE had modest accuracy to detect fibrosis regression without worsening MASH. More effective biomarkers for treatment response are required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.