Metabolic Surgery’s Benefit for MASH-Related Cirrhosis, with Soba Laique, MD

Resmetirom (Rezdiffra) made history in 2024 when it became the first therapeutic to earn US Food and Drug Administration approval for the treatment of metabolic dysfunction-associated steatohepatitis (MASH).¹

Although the approval represented a major breakthrough for the field of hepatology and offered a long-awaited pharmacologic treatment option for many affected patients, it did not address the unmet needs of all MASH patients. Indicated specifically for those with noncirrhotic MASH and moderate to advanced fibrosis, resmetirom’s approval did not include patients with MASH-related cirrhosis, a population that still does not have an FDA-approved treatment.¹

In the absence of medical therapies, recent research has focused on other interventions to help improve outcomes for these patients. Designed to examine the long-term association between metabolic surgery and the risk of progression to major adverse liver outcomes (MALO), the Surgical Procedures Eliminate Compensated Cirrhosis In Advancing Long-term (SPECCIAL) study enrolled patients with compensated biopsy-proven MASH-related cirrhosis and compared outcomes between metabolic surgery and medical management.²

“What our findings revealed was a 72% lower risk of incident MALOs and an 80% lower risk of hepatic decompensation in the surgical group, which are staggering numbers to see,” Sobia Laique, MD, a gastroenterologist and transplant hepatologist at Cleveland Clinic, explained in an interview with HCPLive.

She went on to describe the “substantial” clinical impact of this research, highlighting evidence of a reduced risk of cirrhosis progression with metabolic surgery and the potential implications of these findings for liver transplant eligibility in patients who eventually reach decompensated cirrhosis but otherwise may not have been eligible for transplant due to their weight.

“As physicians, we're always trying to push boundaries and find the next best thing to help our patients,” Laique said.

Looking ahead to research she would like to see conducted in the future, Laique highlighted the need for studies assessing the safety and efficacy of metabolic surgery in patients with severe obesity who have cirrhosis and clinically significant portal hypertension; studies comparing medical therapies with surgical weight loss; and studies exploring metabolic surgery’s potential impact on cirrhosis regression.

References

1. ^{Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed February 3, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash}
2. ^{Brooks A. Metabolic Surgery Improves Long-Term Liver Outcomes in MASH-Related Cirrhosis. HCPLive. January 28, 2025. Accessed February 3, 2025. https://www.hcplive.com/view/metabolic-surgery-improves-long-term-liver-outcomes-mash-related-cirrhosis}