#211 Breaking Down MASLD vs. MASH and the MAESTRO-NASH & ESSENCE Trials: Beyond Journal Club Segment
Core IM | Internal Medicine Podcast
Core IM Team
4.8 • 1.2K Ratings
🗓️ 29 June 2026
⏱️ 36 minutes
🧾️ Download transcript
Summary
MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?
In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.
Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.
This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.
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01:57 | Understanding MASLD as a Systemic Disease
05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease
08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan)
16:15 | Lifestyle Treatment & Weight Loss Targets
19:00 | ESSENCE Trial: Semaglutide for MASH
21:58 | MAESTRO-NASH Trial: Resmetirom
27:27 | Future Treatments for MASH
30:51 | Key Takeaways for Clinicians
Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis
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Transcript
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| 0:00.0 | By and large, we are numb to the noise of stateotically disease. |
| 0:06.0 | You see it all of the time on every scan that is ordered. |
| 0:11.0 | An abnormal ALT is now normal. |
| 0:14.0 | A normal ALT is so rare in most of our patient panels. |
| 0:19.0 | And what these studies and drug approvals mean is that this is the |
| 0:24.8 | time to reevaluate our own patients for their risk of liver-related events. So there's a lot of |
| 0:32.9 | hope bound up in it. Now that we have things that we can do, it validates the condition. |
| 0:40.9 | That's Dr. Elliot Tupper, the academic chief of hepatology at the University of Michigan Health. |
| 0:46.6 | Welcome to Beyond Journal Club, a collaboration between Quariam and N.JM group. |
| 0:51.6 | The goal of Beyond Journal Clubs to take landmark clinical trials |
| 0:54.5 | and put them into context, telling you the story of how we got to where we are and then what it means to take care of our patients. I'm Dr. Shera Chibetty and internist at BADMC. I'm Dr. Greg Katz, cardiologist at NYU. I'm Dr. Clemley, a Medpiz Hospital is in Boston and a guest editor at NEJM. |
| 1:10.5 | And I'm Dr. Alejandro Gampos, |
| 1:12.3 | and a doctoral fellow at NEJM. And I'm Dr. Alejandro Gampos and the doctoral fellow at NEJM. |
| 1:14.9 | All right, so today we're talking about Massel D, whereas some people call it Massel and Mash, as well as two approved drugs that help improve liver fibrosis in these conditions. |
| 1:24.7 | But here's the problem. I think most of us don't actually have a mental model for |
| 1:30.0 | steatotic liver disease. So today we're actually to start with one, a simple framework for why |
| 1:35.4 | this disease happens. Two, how to screen and then risk stratify. And then three, the trials. Essence |
| 1:42.3 | and Maestro Nash published in the Newland Journal of Medicine in April 2025 and February 2024, respectively. |
| 1:49.7 | And it's important to cover it like this, because once you understand the model, the trials and the mechanisms just make sense, including how two different drugs can tackle the same disease through completely different mechanisms of action. |
| 2:01.1 | A quick word from our sponsor, Ostone CME Mix App Audio Companion. |
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