Wegovy Approved for MASH: Hope Against a Vile Disease

I have a friend whose sister died from cirrhosis. It is a painful way to go, one that leaves families feeling powerless and broken. For so long, cirrhosis has meant the end of the road, and the disease that often leads to it, metabolic dysfunction associated steatohepatitis or MASH, has had no treatment options.

That changed today. The FDA granted accelerated approval for Wegovy (semaglutide 2.4 mg) in adults with MASH and moderate to advanced liver fibrosis.

Why This Matters

MASH is often called a silent disease because symptoms rarely show until the liver is already scarred. In the United States, more than 22 million people are living with it. Globally, over 250 million people are affected, and that number is expected to double by 2030. For decades, the only guidance patients received was to lose weight, eat better, move more, a prescription that too often ignored the biological complexity of the disease.

Now, for the first time, there is a therapy that not only halts progression but shows signs of reversing the damage.

The Breakthrough

The FDA’s decision is based on the ESSENCE trial, which showed at 72 weeks:

• 36.8% of patients treated with Wegovy improved their liver fibrosis with no worsening of MASH, compared to 22.4% on placebo.

• 62.9% of patients achieved resolution of MASH without worsening fibrosis, compared to 34.3% on placebo.

These results mean livers spared from cirrhosis and families spared from unthinkable loss.

The Bigger Picture

Wegovy is now the first and only GLP-1 medication approved for MASH. It adds to existing approvals for obesity and cardiovascular risk reduction. That means weight loss, heart health, and liver protection in a single treatment.

But here is the question that matters most for patients: will they be able to access it?

Millions of Americans already struggle to get GLP-1 coverage for obesity, fighting insurance denials and impossible out-of-pocket costs. Adding MASH as a new indication should, in theory, open more doors, especially because untreated MASH can lead to cirrhosis, liver transplant, or death. From a health economics standpoint, paying for Wegovy is far cheaper than paying for end-stage liver disease. But history tells us the road to coverage is never that simple. Insurers may drag their feet. Prior authorizations may pile up. And the patients who need this therapy most could find themselves locked out once again.

Looking Ahead

Wegovy is available in the United States today for this new indication. Part 2 of the ESSENCE trial will study whether it prevents liver-related complications over the long term, with results expected in 2029. That means today’s approval is a beginning, not the end.

For anyone who has lost someone to cirrhosis, this news brings hope. But hope without access will not save lives. The next chapter will be written not just in labs or clinics but in insurance offices, policy debates, and the appeals patients file when coverage is denied.

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