Effects of Resmetirom on Metabolic-Dysfunction Associated Steatohepatitis in Patients With Weight Loss and/or Diabetes Taking Glucagon-Like Peptide-1 Receptor Agonists and Other Diabetes Therapies: A Secondary Analysis of the MAESTRO-NASH Trial

Background: MAESTRO-NASH, a randomised, double-blind, placebo-controlled, 54-month phase 3 trial evaluating the efficacy of resmetirom in patients with biopsy-confirmed metabolic-dysfunction associated steatohepatitis (MASH) and liver fibrosis achieved primary endpoints of MASH resolution with no worsening of fibrosis, and ≥ 1-stage improvement in fibrosis with no worsening of MASH at 52-weeks. Aims: The effects of resmetirom (80 or 100 mg) versus placebo were evaluated on Week 52 histological and biomarker endpoints in relation to background treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i), GLP-1 receptor agonists (GLP-1 RA), and/or ≥ 5% weight loss at Week 52. Methods: At baseline, 13%–17% of patients (all with type 2 diabetes mellitus [T2DM]) were on stable GLP-1 RA or SGLT2i therapy. Changes in liver histology, MRI-proton density fat fraction (MRI-PDFF), and liver stiffness were examined after 52 weeks of treatment. Results: No weight loss above baseline occurred with GLP-1 RA or SGLT2i therapy. SGLT2 and GLP-1 RA treated patients showed similar rates of MASH resolution and fibrosis improvement in combination with resmetirom as patients not on these therapies. Resmetirom-treated patients (100 mg) with weight loss (≥ 5%) compared with those with weight loss < 5% had higher rates of MASH resolution (56.6% vs. 33.8%), fibrosis improvement (40.6% vs. 31.5%), MRI-PDFF reduction (−69% vs. −46%), and liver stiffness reduction after 52 weeks of treatment (−4.6 kPa vs. −2.3 kPa). Conclusions: The efficacy of resmetirom on multiple MASH endpoints was not impacted by background SGLT2i or GLP-1 RA treatment. Weight loss (≥ 5%) enhanced the efficacy of resmetirom. Trial Registration: MAESTRO-NASH ClinicalTrials.gov number, NCT03900429.