The beginning of June saw the publication of four trials assessing the efficacy and safety of incretin-based drugs in steatotic liver disease and cirrhosis, coinciding with the European Association for the Study of the Liver 2024 Congress (5–8 June).

In a phase II, dose-finding, multicentre, double-blind clinical trial (SYNERGY-NASH), Rohit Loomba and colleagues assessed the safety and efficacy of tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)–GLP1 receptor agonist, in 190 patients with biopsy-confirmed MASH and stage F2 or F3 liver fibrosis. Participants were randomly assigned to receive once-per-week subcutaneous injections of tirzepatide at doses of 5 mg, 10 mg or 15 mg, or a placebo for 52 weeks. Resolution of MASH without worsening fibrosis (primary endpoint) was met (P < 0.001 for all three groups versus placebo) in 44% of the patients in the 5-mg group (95% CI 17–50), 56% in the 10-mg group (95% CI 29–62) and 62% (95% CI 37–69) in the 15-mg group, compared with 10% in the placebo group. Secondary endpoints were also met, including improvement of ≥1 stage in fibrosis in 55% of patients in the 5-mg group (95% CI 5–46), 51% in the 10-mg and 15-mg groups (95% CI 1–42 for both groups), versus 30% in the placebo group. The most common adverse effects were mild-to-moderate gastrointestinal events.