Trial Patients Show Less Activity, More Fibrosis
Researchers report that patients screened for MASH trials now present with less disease activity but more advanced liver scarring.
Updated on Nov. 7, 2026 in Diabetes
Patients screened for MASH trials show less disease activity but more advanced fibrosis, according to findings presented by Dunn at AASLD's The Liver Meeting 2026. Trial screening protocols have improved at identifying patients with fibrosis through VCTE and ELF testing.
Why it matters
GLP-1 use has lowered ballooning over time, which reduces disease activity, while fibrosis responds more slowly and remained present in patients who had taken these drugs. This shift changes which patients qualify for trials and how researchers measure progress in MASH.
The analysis compares SMART-MASH against the Agile 4 screening tool, with SMART-MASH identifying about a third more patients with cirrhosis. Patients in the dataset had taken GLP-1 drugs for a median of about 1 year, but no effective tool yet exists to identify ballooning.
The players
Dunn
Dunn is a researcher at the University of Kansas Medical Center who presented the MASH screening findings at AASLD's The Liver Meeting 2026.
AASLD's The Liver Meeting
The Liver Meeting is the annual conference of the American Association for the Study of Liver Diseases, a major forum for hepatology research.
The details
SMART-MASH screens patients using VCTE alone in a third of cases, VCTE plus ELF in another third, and point-of-care labs in the remainder, and it achieved a higher area under the curve than Agile 4. Dunn, of the University of Kansas Medical Center, presented the findings at AASLD's The Liver Meeting 2026.
Timeline
2026: Dunn presents findings at AASLD's The Liver Meeting 2026.
Health Landscape
The finding extends the growing use of GLP-1 drugs in metabolic disease, where lowering ballooning shifts the disease profile of people enrolling in MASH trials. This points to a broader change in how the liver disease population is defined for research and treatment.
For people with fatty liver disease, the shift means that patients enrolling in trials may now have more advanced scarring even as day-to-day disease activity looks lower. Anyone managing liver health should discuss current fibrosis staging with their clinician rather than relying on activity markers alone.
The takeaway
Liver disease staging is becoming more complex as drug treatments change disease activity faster than scarring. Readers with MASH or related risk factors should ask their doctors how both activity and fibrosis are being measured.
Further reading
For broader background on the metabolic conditions behind this research, see our Diabetes coverage.
