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NASH Cirrhosis — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyNASH CirrhosisRACP Adult Medicine

A 55-year-old man with non-alcoholic steatohepatitis (NASH) cirrhosis has a FIB-4 score of 4.2 and liver stiffness of 18 kPa on FibroScan. He has no varices on screening endoscopy. His BMI is 35 and HbA1c is 62 mmol/mol. What is the most important pharmacological intervention for NASH management?

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Correct answer: B — GLP-1 receptor agonist (semaglutide)

While resmetirom (Rezdiffra) is the first FDA-approved NASH-specific therapy, GLP-1 RAs (semaglutide) have shown significant benefit for NASH resolution in the SEMA-NASH trial and address multiple metabolic comorbidities (obesity, diabetes, cardiovascular risk). Pioglitazone and vitamin E have been used but vitamin E is not recommended in cirrhotic NASH or diabetic patients. Lifestyle modification (weight loss >10% of body weight) remains the cornerstone.

Reference: eTG – 2025 – Gastrointestinal; AASLD – 2023 – NAFLD/NASH Guidance