Two medicines for fatty liver disease reached the UK market this summer. A study published this month shows most people are still being identified far too late.
Fatty liver disease rarely announces itself. Now known as MASLD, it develops quietly over years and is closely linked to obesity and type 2 diabetes. Its advanced form, MASH, causes inflammation, scarring and, in time, cirrhosis or liver cancer.
Research published on 4 September in the European Journal of Internal Medicine sets out what happens when that goes unnoticed. Of 82,402 people admitted to hospital in England as an emergency with chronic liver disease, 59.9% died within five years, with median survival of 2.7 years. For around three in four, that admission was the first time their liver disease came to hospital attention.
The work was led from London, by academics at King’s College Hospital, King’s College London and the London School of Hygiene and Tropical Medicine, under the NIHR-funded MAP-CLD programme. Professor William Bernal, who led it, said the disease is often advanced by the time patients present this way. The study also found nearly half of patients were not under the care of a liver specialist during that admission, and that patients living outside London faced a higher risk of death once age, severity and cause were accounted for.
A pipeline that has finally moved
For most of the past decade, treatment meant weight loss and managing related conditions. That changed this year. In June the MHRA authorised resmetirom, sold as Rezdiffra, for adults with MASH and moderate to advanced fibrosis, the first medicine licensed in the UK specifically for MASH with liver scarring. It drew on a trial of more than 900 adults, in which roughly 26 to 30% achieved resolution of MASH without worsening fibrosis after 12 months, against about 10% on placebo.
In early July the regulator granted semaglutide, sold as Wegovy, a conditional authorisation for the same group. Liver UK, the new name for the British Liver Trust, welcomed both decisions while noting that neither will be routinely funded on the NHS until NICE completes its appraisals.
Why studies are still recruiting
Two approvals do not settle the field. Questions remain about how these medicines perform alongside each other, how people at earlier stages of fibrosis respond, and whether scans and blood markers can replace biopsy. That is where London research is working, alongside studies of other drug classes.
Eligibility usually rests on risk factors rather than symptoms: a raised BMI, type 2 diabetes, high blood pressure or abnormal liver blood tests. Screening tends to involve blood tests and a scan such as transient elastography, which measures liver stiffness. Anyone weighing up a study can compare what is being investigated across trials currently recruiting participants in the UK before approaching a site.
Questions worth asking first: which phase the study is at, whether there is a placebo arm, and what happens at the end. All UK studies require ethics approval and MHRA oversight, and taking part is voluntary throughout.
For people with risk factors but no diagnosis, the MAP-CLD point is the immediate one. Fatty liver disease found early can be managed. Found in an emergency department, it often cannot. Anyone considering research can review eligibility criteria for studies open to new participants and discuss it with their GP.
This article is for general information and is not medical advice. Anyone concerned about their liver health, or considering taking part in a clinical trial, should speak to their GP or specialist.
