Lizy Gill, Ipsos MASH Therapy Monitor October 2025
MASH AT A TURNING POINT. AGAIN.
Rezdiffra, GLP-1s, and the Shift to Earlier Care
Lizy Gill, Ipsos MASH Therapy Monitor October 2025
MASH AT A TURNING POINT. AGAIN.
Rezdiffra, GLP-1s, and the Shift to Earlier Care
Lizy Gill, Ipsos MASH Therapy Monitor October 2025
Introduction
MASH (or, metabolic dysfunction-associated steatohepatitis) is a silent, often underestimated disease with serious implications, including liver scarring, liver cancer, transplant dependency, and even death.
Although MASH unmet needs have long been clear – to improve patient identification, diagnose sooner and treat earlier – it was only last year that the first ever MASH therapy was approved. Now, hot on the heels of this significant milestone, the MASH treatment landscape is changing again…
Following the failure of multiple drug candidates in late-stage clinical trials, Rezdiffra became the first medication approved to treat MASH in 2024. It was given the green light by the FDA in March 2024 (for adults with moderate-to-advanced liver fibrosis), followed by conditional marketing authorisation from the European Commission in August 2025 for the same.
Now, this nascent treatment landscape is on the cusp of further evolution thanks to recent FDA approval of GLP-1, Wegovy, for MASH patients with moderate-to-advanced fibrosis. And with over 80 other MASH products in the pipeline – with competing mechanisms of action, spanning all stages of the disease – it’s bound to change further in the coming years.
Three emerging dynamics, explored further in this article, are likely to shape the future of MASH care:
- The evolving role of the physician in the MASH care pathway
- The growing need for reliable identification of MASH and the significance of comorbidities
- The emergence of new treatment strategies
Pharma’s ability to anticipate and respond to these dynamics will determine who wins in this fast-moving space.
Unravelling the MASH Care Pathway
The MASH care pathway is a labyrinth of networks, from patient presentation and diagnosis to treatment and ongoing management, with referrals often happening too late.
Currently, a range of specialties play a part in identifying and diagnosing MASH; liver specialists, in particular, are integral throughout the MASH care pathway, especially from diagnosis onwards where their expertise is critical.
But now a new care pathway is emerging, and new connections developing, thanks to the availability of GLP-1s. Why? GLP‑1s are widely approved to treat obesity and type 2 diabetes, and much of this demand is channelled through primary care physicians (PCPs) and metabolic specialists prescribing to consumers paying out-of-pocket. Therefore, it’s likely that these physicians will play a larger role in diagnosing, treating and monitoring MASH. Impacts will obviously vary by country (depending on GLP-1 availability, reimbursement and prescribing pathways), but this shift moves MASH management upstream in primary care, enabling earlier intervention and more holistic, comorbidity‑led care.
Over half (57%) of the EU liver specialists in Ipsos’ MASH Patient Journey Monitor expect MASH diagnoses to increase with an approved GLP-1 available.
Source: Ipsos MASH Patient Journey Monitor (202 physicians in France, Germany, Italy & Spain providing de-identified treatment data, online, on MASH patients seen in consultation in Jan-Mar ’25) © Ipsos, 2025.
Pharma companies active in MASH will need to identify the healthcare professionals (HCPs) that are more involved in diagnosis and treatment decisions, and facilitate greater collaboration between PCPs, liver specialists and non-liver specialists such as Endocrinologists.
This will enable timely referrals, maximise specialist knowledge at each step, and manage patient comorbidities, which influence how the MASH patient is treated and which drugs are used.
Decoding MASH Diagnosis
MASH diagnosis is often overshadowed by other conditions, as illustrated by Ipsos data:
A large proportion of the HCPs in our MASH Therapy Monitor were unsure which lab values differentiate MASH from MASLD in a patient.
Source: Ipsos MASH Therapy Monitor (663 physicians in US, Germany, Japan, China & Brazil providing de-identified treatment data, online, on MASH patients seen in consultation in Oct ’24-Jan ’25)
Furthermore, diagnosis and treatment strategies differ by specialty, particularly in handling comorbidities and setting priorities. As a result, MASH may not be prioritised:
Over a quarter (27%) of physicians surveyed in US and Germany prioritised treating cardiovascular disease, chronic kidney disease and morbid obesity over MASH.
Source: Ipsos MASH Therapy Monitor (663 physicians in US, Germany, Japan, China & Brazil providing de-identified treatment data, online, on MASH patients seen in consultation in Oct ’24-Jan ’25)
At the same time, however, the availability of more treatment options will raise awareness of MASH and drive broader screening, diagnosis and treatment. Translating that into improved outcomes requires better patient identification, which enables patients to be diagnosed sooner and initiated onto the most appropriate treatment.
The Race to Define the Treatment Algorithm
Today, in the approved markets, MASH treatment is led by two products with different mechanisms of action and reimbursement/insurance coverage statuses, but a complementary profile:
- Rezdiffra, an orally administered thyroid hormone beta-receptor (THR-β) agonist, which addresses liver-related issues by targeting fibrosis and the hepatic roots of MASH. It has already made significant inroads in MASH treatment, evidenced by manufacturer Madrigal’s reports of 23,000 patients already on the treatment and a 55% increase in quarterly revenues.
- Wegovy, an injectable GLP-1 receptor agonist, which is already approved for obesity and only recently for MASH, and which has – according to Ipsos data below – already been in use off-label to treat MASH, thanks to the high overlap of this condition with obesity and type 2 diabetes.
According to our US data, 48% of MASH patients on a GLP-1 (and not on Rezdiffra) were prescribed it to treat obesity and coexisting conditions.
Source: Ipsos MASH Therapy Monitor (663 physicians in US, Germany, Japan, China & Brazil providing de-identified treatment data, online, on MASH patients seen in consultation in Oct ’24-Jan ’25)
The approval of Wegovy for MASH will certainly impact treatment strategy. Yet, with a treatment landscape still in its infancy, it is unclear how the treatment algorithm will take shape and whether Rezdiffra or Wegovy will be used. Some of the physicians in our MASH Therapy Monitor (Q1 ’25) have reported employing combination GLP-1 and THR-β agonist therapy, optimising the respective strengths of these treatments to address the full spectrum of disease mechanisms.
Understanding how HCPs are prescribing these two options, and for which patients, is key to determining the evolution of the MASH landscape. Will GLP-1s become the backbone treatment for MASH given the high incidence of overlapping metabolic comorbidities? Or will Rezdiffra continue to benefit from its first-mover positioning, building on the positive physician experience so far and with diagnoses of MASH likely to increase?
Conclusion
New drugs are heralding a new era of treatment, giving unprecedented options to HCPs and patients. These, in turn, are likely to increase awareness of MASH.
To take full advantage of these changes and shape the emerging MASH care pathway, pharmaceutical companies in this space must rise to the three challenges identified:
- Follow how the patient flow is evolving from timings and methods of diagnosis to the shifting responsibilities of HCPs involved in patient care
- Understand how the use of available treatment options is unfolding, creating distinct patient types based on varying degrees of patient complexity
- Aligning drug benefits to the unique requirements of these patient types
About the Research
Ipsos has long been monitoring the MASH treatment landscape, collecting real-world patient data, layered with HCP perceptions, since 2017. The Ipsos MASH Therapy Monitor provides an in-depth understanding of current diagnosis and treatment dynamics, with future-looking insights into how the landscape is likely to evolve among specialists and PCPs across different markets. Our next wave will launch in Q1 2026 with a focus on monitoring changes since the US launch of Rezdiffra last year, identifying the impact of the recent approval of Wegovy, and anticipating the upcoming launch of Rezdiffra in Germany.
Data are © Ipsos 2025, all rights reserved.
