Wegovy (semaglutide 2.4 mg) is FDA-approved for MASH with moderate to advanced fibrosis (accelerated approval, August 2025). Tirzepatide resolved MASH in 44–62% of patients in the phase 2 SYNERGY-NASH trial but has no MASH indication.
The evidence
SYNERGY-NASH (NEJM 2024): tirzepatide 5/10/15 mg vs placebo in F2-F3 fibrosis MASH. MASH resolution: 44%, 56%, 62% by dose vs 10% placebo at 52 weeks. ESSENCE part 1 (NEJM 2025): semaglutide 2.4 mg in F2-F3 MASH; MASH resolved without worsening fibrosis in 62.9% vs 34.3% on placebo at 72 weeks, and fibrosis improved in 36.8% vs 22.4%.
FDA-approved labeling status
Wegovy received accelerated approval on August 15, 2025 for noncirrhotic MASH with moderate to advanced fibrosis (F2 to F3) in adults; continued approval depends on ESSENCE part 2. Tirzepatide has no FDA MASH indication as of October 16, 2026. On Medicare, people with fatty liver disease are not eligible for the GLP-1 Bridge; Medicare.gov says their Part D plan might cover a GLP-1.
Practical considerations
Patients with biopsy-confirmed MASH and F2-F3 fibrosis are the population studied. Hepatology coordination is essential. Compounded semaglutide and tirzepatide are not FDA-approved and were not studied in these trials.