Hersh Shroff, MD, MPA, is a transplant hepatologist and an assistant professor of medicine at the University of North Carolina School of Medicine

Hersh Shroff, MD, MPA

This Year in Hepatology: New MASLD Therapies, HBV Updates, and More

2025 has marked a clear turning point in 

, bringing advances that are reshaping both the scientific landscape and everyday clinical practice. After years defined by limited therapeutic options and slow-moving pipelines, this year delivered transformative progress, from the long-awaited arrival of effective pharmacologic treatments for 

, cholestatic liver diseases, portal hypertension, and alcohol-associated liver disease.

However, the momentum extends well beyond new drugs. Emerging noninvasive diagnostics, evolving disease definitions, AI-enabled pathology, and increasingly patient-centered care models are redefining how clinicians detect, stage, and manage chronic liver disease. Together, these shifts signal a rapidly accelerating era in hepatology that is expanding treatment opportunities while reshaping clinical expectations.

To capture the breadth of this evolution, the editorial team of 

 invited 7 leading experts to weigh in on the most important advances of 2025:

, an assistant professor of medicine and director of the IHEAL Clinic at the University of North Carolina School of Medicine:

I think in the past year, the biggest news has been the increasing use of medications to treat metabolic dysfunction associated-steatotic liver disease, formerly known as fatty liver disease. The weight loss medications, the GLP-1 receptor agonists, are really changing the game for this disease process. Resmetirom is another new medication we have, and just given the sheer number of patients that we have with this disease process, now finally having medications to treat them, albeit with insurance barriers, which we're working on, but I think it's really promising to be able to at least have options for these patients. Hopefully the government and local partners can help bring the prices of these medications down and increase access, because they really are beneficial.

, chairman of the Global NASH/MASH Council and professor and chairman of Beatty Liver and Obesity Research at Inova Health System:

I think the biggest news in hepatology is the drugs that we are developing for MASH. Resmetirom, semaglutide, and probably the new drugs with FGF21s, so hopefully we'll see the results next year. There is also a lot of interest in other liver diseases, understanding the dynamic nature of what we call steatotic liver disease between MASLD, MetALD, and ALD, that this is a dynamic disease that goes back and forth. So that's an important concept to understand, and there is also some hope in terms of better treatment for viral hepatitis, especially delta hepatitis, which may not be a major issue in the United States but is a major issue in some other parts of the world. So all of these actually gave me more hope that we are going to see more and more innovation and interest in this area.

, a transplant hepatologist and assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School:

There have been a few pieces of breaking news in the past year. First, I'd say the most important is steatotic liver disease, and now we finally have 2 approved medications to treat patients with MASH. We used to have no other, or very little, options, except for exercise and lifestyle modification, which is very important, but also hard to do. But now we have medications that actually have been proven to be effective in reducing steatosis and also fibrosis in those patients, so it can prevent further development of advanced liver disease.

Obviously, in addition to that, we're also trying to use a combination of pharmacotherapy and behavioral therapy so once patients lose weight, they'll continue to stay in that weight for a long period of time, and that disease can be controlled or even resolved. In addition to that, what I have noticed is that alcohol-related liver disease continues to be paid attention to. In our liver disease society, we have more researchers, we have more findings in this field, and more and more people are realizing that pharmacotherapy is something that could be utilized by us to manage patients with alcohol-related liver disease, and integrated clinics actually are more utilized across the academic medical centers to manage those patients.

The third part that I've noticed is there are more lectures and more attention that is paid to address psychosocial and structural determinants in patients with chronic liver disease, for example, stigma. This year, we have a specific session for stigma and also psychosocial structural barriers. I think we're paying more and more attention in this area, which is very important, because how patients feel about their disease is also extremely important as to how we can manage and help their disease itself.

, the head of hepatology at University Hospital Zurich:

I don’t want to break it down to one piece of biggest news. I think we have seen a lot of changes from treating underlying diseases, such as in rare cholestatic liver disease the switch to symptom burden, which is more and more addressed in many disorders, which I think is very important to our patients. They sometimes care more about improved symptoms rather than an improved laboratory parameter.

We also see great developments in the field of MASLD and also fibrotic or cirrhotic MASLD. The problem is so far, we have always relied on histology, and we see clear trends towards artificial intelligence based pathology investigations or noninvasive tests to overcome the need for biopsy on a study drug, where we, hopefully, in the future, have certain definitions that indicate this is associated with improved histology, so that we can avoid biopsy and purely rely on noninvasive parameters, whether this is an Agile 4 combined laboratory parameter or a certain elastography-based measurement needs to be shown in the end. There's a clear trend in this large disease moving away.

I think these are important messages and various other aspects a little bit, depending on whom you ask, but I think quite intriguing news we have learned here in Washington, DC.

, chief academic officer of Summit Clinical Research and director of the Steatotic Liver Program at North Shore Gastroenterology:

I think being in the field of hepatology has been very exciting in the last few years. We have new treatments that are being developed for hepatitis B to achieve functional cure, and I think this will be a great addition for these patients. We also see new therapeutics being developed to treat portal hypertension, and these patients have very advanced liver disease. They're on the cusp of decompensation, so if we can take them back into a more stable stage of their disease, that will be a very important development. We are also seeing many new therapeutics to treat cholestatic liver disease, both PSC and PBC, and we also see treatments for genetic cholestasis diseases like progressive familial intrahepatic cholestasis. There's many, many new biomarkers that are being developed and screening algorithms to increase awareness of chronic liver disease in general, so I couldn't be happier to be a hepatologist.

, a professor at the Baruch S. Blumberg Institute and president of the Hepatitis B Foundation:

We have 2 new treatment guidelines for hepatitis B. EASL came out with their hepatitis B guidelines earlier in the year, and AASLD just came out with their updated hepatitis B guidelines a few days ago. We're excited to see how those are going to be implemented. We are excited as a community to have expanded treatment guidelines, and one of the central tenets of both of those guidelines is shared decision-making. We're very, very pleased to see that medical societies are paying attention to what the patient wants and understanding that the decision to initiate treatment should be a shared one between a clinician and a patient.

, a professor of medicine at Houston Methodist Hospital and co-chairman of Summit Clinical Research’s Board of Directors 

I think there are a million biggest pieces of news this year. We can talk about that for an hour, but I think the MASH field just got another big boost. There were multiple acquisitions this year, the efruxiferm acquisition, the pegozafermin acquisition, and the efimosfermin acquisition. In addition, pemvidutide came with a primary endpoint, so now we have multiple attractive phase 3 trials. With having big sponsors, I think we'll start seeing combination therapy and more trials going on. This is probably the hottest year for the MASH field ever, and I look forward to many good years coming down.

 reports relevant disclosures with Intercept, Gilead, Boehringer Ingelheim, Ipsen, Bristol-Myers Squibb, GSK, NovoNordisk, Siemens, Madridgal, Merck, Akero and Abbott. 

 reports relevant disclosures with AbbVie, AstraZeneca, Bayer, CymaBay, Gilead, GlaxoSmithKline, Intercept, Mirum, Takeda, Ipsen, and others. 

 reports relevant disclosures with Altimmune, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Rivus, Takeda, and others. 

 reports relevant disclosures with Gilead Sciences, GlaxoSmithKline, Vir Biotechnology, Dynavax Technologies, and Roche. 

 reports relevant disclosures with Gilead, GlaxoSmithKline, Madrigal, Novo Nordisk, Takeda, 89BIO, Altimmune, Boehringer Ingelheim, and others.

Younossi ZM, Zelber-Sagi S, Lazarus JV, et al. Global Consensus Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis. Gastroenterology. 2025;169(5):1017-1032.e2. doi:

​Bansal MB, Patton H, Morgan TR, Carr RM, Dranoff JA, Allen AM. Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD Practice Guidance. Hepatology. Published online November 7, 2025. doi:

European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2025;83(2):502-583. doi:

Articles

The year 2025 has marked significant advancements in hepatology, transforming both scientific research and clinical practice. Notable progress includes the introduction of effective pharmacologic treatments for MASLD/MASH, innovations in viral hepatitis, cholestatic liver diseases, and alcohol-associated liver disease. Additionally, noninvasive diagnostics, AI-enabled pathology, and patient-centered care models are redefining chronic liver disease management. Experts highlight the importance of new medications, the dynamic nature of steatotic liver disease, and the role of psychosocial factors in patient care, signaling a rapidly evolving era in hepatology.

Recent advancements in hepatology highlight new medications for metabolic dysfunction and liver diseases, promising improved patient outcomes and treatment options.

2025 in Hepatology: New MASLD Therapies, HBV Updates, and More

Utilizing Alcohol Use Disorder Pharmacotherapy in Hepatology, With Hersh Shroff, MD, MPA

New research is shedding light on low rates of prescriptions for alcohol use disorder (AUD) medications among liver transplant recipients with a history of alcohol-associated liver disease (ALD).

American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025

 by Hersh Shroff, MD, MPA, an assistant professor of medicine and director of the IHEAL Clinic at the University of North Carolina School of Medicine, and suggest gastroenterologists and hepatologists may be uncomfortable prescribing these medications in this patient population despite their proven safety and efficacy.

“We know that those 2 conditions, the liver disease and the addiction, and sometimes a third condition of mental health, are all so intricately tied together that to me, you can't address one without addressing the others,” Shroff explained to 

However, he notes many hepatologists are not trained to deal with addiction or mental health, creating a sense of discomfort among clinicians treating patients with ALD and AUD who may not fully understand how to approach the disease and may have misconceptions about utilizing AUD pharmacotherapy.

Previous research has shown alcohol use disorder pharmacotherapy is rarely utilized in patients with high-risk clinical history, including ALD. In one analysis of commercial insurance data from PharMetrics Plus for Academics, results showed only about 2% of eligible patients with ALD received a pharmacotherapy for AUD.

To provide data contextualizing use of these medications in hepatology in the setting of transplantation, Shroff and colleagues conducted a retrospective study using deidentified patient data from Epic Cosmos for liver transplant recipients ≥ 18 years of age transplanted in the US between January 2015 and December 2023 with a diagnosis of ALD.

Since the primary indication for transplantation is not available in Cosmos, investigators were unable to confirm that ALD was the primary indication for transplant. They included results of ethanol biomarkers any time after liver transplant and AUD medication prescriptions for baclofen, naltrexone, and acamprosate within 1 year after transplant.

A total of 17,975 patients were included in the study cohort, representing 56% of all US liver transplants during the period. Among the cohort, the average age was 54 ±11 years at the time of transplant, 31% of patients were female, and 72% had a documented concomitant diagnosis of an alcohol-related disorder. Of 6168 (34%) patients with an available ethanol biomarker test, 913 (15%) were positive for an ethanol metabolite.

During the study period, 3.4% of patients were prescribed a medication for alcohol use disorder within 1 year after liver transplant (1.9% baclofen, 0.84% naltrexone, 0.85% acamprosate). Investigators noted these prescriptions increased significantly during the study period, from 16 (2.0% of transplant recipients) in 2015 to 164 (6.2% of transplant recipients) in 2023 (

= .001). Specifically, baclofen prescriptions increased from 1.8% in 2015 to 2.0% in 2023 (

= .255), naltrexone increased from 0.8% in 2018 to 1.9% in 2023 (

= .093), and acamprosate increased from 1.0% in 2021 to 2.9% in 2023 (

“At meetings like this, all of us get together and share what we know and what our experience has been. I think sharing this more broadly with people, even outside of hepatology, [is important because] there's still a perception that a lot of these medications may be unsafe, and we're trying to dispel that notion,” Shroff said, additionally emphasizing the importance of patient involvement. “There's a perception and a stigma around using medications for various types of addiction, and I think it's important to break that. There's a big need for partnership and increased research, just like what we're doing.”

Editors’ Note: Shroff reports no relevant disclosures.

Shroff H, Fix O, Deutsch-Link S. Increasing Rates of Pharmacotherapy Prescriptions for Alcohol Use Disorder After Liver Transplantation: An Analysis of Epic Cosmos Data. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

Kunzmann K. Patients with Liver Disease Rarely Get Alcohol Use Disorder Pharmacotherapy. 

. October 30, 2024. Accessed November 7, 2025. 

https://www.hcplive.com/view/patients-with-liver-disease-rarely-get-alcohol-use-disorder-pharmacotherapy

Videos

Shroff emphasizes the need to address more than just liver health in patients with alcohol-associated liver disease and reviews trends in AUD pharmacotherapy prescriptions.

Discussion between 3 subject matter experts on the impact of stigmatization on outcomes of alcohol-related liver disease.

HCPLive Alcohol Stigma Discussion Part 2

Shame derived from structural or self-stigma may inhibit patients from obtaining treatment for their 

. This could be because patients might downplay their drinking problems. By internalizing cultural norms surrounding 

, those with alcohol-related liver disease might fear being labeled as an “alcoholic.” 

The healthcare system was designed to separate addiction and hepatology care. Patients would see their alcohol or addiction specialist for alcohol-related issues and would see their hepatology specialist for liver problems. This contributes to patients feeling like they are the ones to be blamed—that their alcohol use was the sole reason they had developed liver disease.

However, this is not true. Although alcohol can lead to liver problems, other causes such as genetics or obesity can lead to liver issues, too.

Research suggests work needs to be done on de-stigmatizing alcohol-related liver disease. A 

 revealed limited usage of non-stigmatization language for AUD and alcohol-related liver disease, underscoring the need for more patient-centered language in transplant centers.

 special report, Hersh Shroff, MD, MPA, moderated a conversation between hepatology specialist Jay Luther, MD, and addiction specialist Chris Kahler, PhD, to discuss the stigmatization of AUD and how hepatologists and addiction specialists can work to collaborate to give patients improved care.

The first part of the report focused on the different types of stigma and how the stigma around AUD may contribute to delays in seeking care for liver disease. The second half of the discussion pivoted to how the collaboration between hepatology and addiction specialists may reduce the stigma surrounding alcohol-associated liver disease.

“To expect that the individual necessarily will have full control over their capacity to say, ‘I can stop drinking tomorrow’ is not realistic for many people,” Kahler said. “It involves not just the involvement of psychiatrists, but social workers, or psychologists, other people who can think about the social determinants of health because those are often driving factors both in alcohol use, but also in delays in seeking care.”

He added the importance of peer support or recovery coaches to share experiences with to reduce the stigma. He also said screening for unhealthy alcohol use is important, rather than a doctor telling their patient, “I think you need to quit drinking.” Kahler stressed the importance of referring the patient to a liver specialist so they can examine actual negative impacts instead of making assumptions.

“Catching patients early or getting patients in who are at high risk for developing disease, so they never develop disease… are critical pieces to the puzzle that…need more attention,” Luther said.

Check out the first half of the discussion: 

https://www.hcplive.com/view/recognizing-stigma-impact-care-alcohol-related-liver-disease

 a transplant hepatologist and an assistant professor of medicine at the University of North Carolina School of Medicine

 an assistant professor of medicine at Harvard Medical School and director of the Massachusetts General Hospital Alcohol Liver Center

 a professor of behavioral and social sciences, a professor of psychiatry and human behavior, and the director of the Center for Alcohol and Addiction Studies at Brown University

Shroff, Luther, and Kahler have no relevant disclosures.

Schomerus G, Leonhard A, Manthey J, et al. The stigma of alcohol-related liver disease and its impact on healthcare. 

. 2022;77(2):516-524. doi:10.1016/j.jhep.2022.04.026

Mahle R, Okanlawon A, Luther J, Louissaint J, Zhang W. Stigmatizing Language for Alcohol Use Disorder and Liver Disease on Liver Transplant Center Websites. 

. 2024;7(2):e2355320. Published 2024 Feb 5. doi:10.1001/jamanetworkopen.2023.55320

Brooks, A. The Power of Words: Liver Transplant Centers Continue to Use Stigmatizing Language. 

https://www.hcplive.com/view/the-power-words-liver-transplant-centers-continue-use-stigmatizing-language

The second segment of a special report stresses the importance of cross-specialty collaboration with hepatology and psychiatry when treating alcohol-related liver disease.

Addressing Stigma to Improve Outcomes in Alcohol-Related Liver Disease

Discussion between 3 subject matter experts on the impact of stigmatization on delays in diagnosis of alcohol-related liver disease.

HCPLive Alcohol Stigma Discussion Part 1

Recent years have seen a drastic increase in alcohol use in the United States. Alongside this growing prevalence has come an influx of severe morbidity and mortality linked to 

, with the National Institute on Alcohol Abuse and Alcoholism citing alcohol’s involvement in nearly half of all liver disease deaths among people 12 years of age and older in 2022 and labeling alcohol as one of the leading causes of preventable death.

Many cases of ALD are rooted in underlying 

, a medical condition involving frequent or heavy alcohol consumption that often requires an individualized treatment approach with a combination of medication, behavioral interventions, and mutual support groups. According to the 2022 National Survey on Drug Use and Health, 29.5 million people ages 12 and older had AUD in the past year. Of this group, 2.2 million received alcohol use treatment.

Although it is a mental health disorder, AUD’s role in the development and progression of ALD underscores the importance of its treatment alongside medical intervention for the liver and other potential negative physical impacts of alcohol use. However, it tends to fall by the wayside due to a number of patient, clinician, and system barriers, many of which are linked to the stigma surrounding AUD and its negative impact on patients’ willingness to seek care as well as clinicians’ ability to provide adequate care.

In this HCPLive special report, our moderator, Hersh Shroff, MD, MPA, is joined by Jay Luther, MD, and Chris Kahler, PhD, to discuss the stigmatization of AUD. The first segment of their conversation focuses on defining stigma, both at the public and structural level, and outlining its role in delaying and hindering care for these patients.

Shroff introduces the topic and poses a question to Kahler about the different forms and definitions of stigma and how public perception of AUD may contribute to delays in seeking care. Kahler responds by describing stigma as a “complex construct,” explaining its manifestation at both social structural levels and individual levels as well as how the stigma surrounding AUD may lead patients to underreport their alcohol consumption, avoid discussing concerns with their clinician, and hesitate to seek care from a specialist.

Shroff expresses agreement with Kahler’s response and poses a similar question to Luther, this time inquiring about how structural stigma in the health care system perpetuates disparities for patients with ALD. Similar to Shroff, Luther notes he agrees with Kahler’s response and mentions how certain aspects of this individualized stigma are also present at a greater structural level.

He goes on to describe how the disease has been labeled, pointing to inherent problems with the terms alcoholic liver disease and alcoholic hepatitis and how the term “alcoholic” contributes to the ongoing stigma in ways clinicians may not even realize. Structurally, Luther notes that there has been little to no overlap between the treatment of liver disease and the treatment of alcohol addiction, forcing patients to see different specialists and potentially making them feel as though they are being judged or blamed for their alcohol use.

However, Luther goes on to explain how some institutions, including his own, are taking strides to combat this structural stigma by incorporating what he calls a “team approach” with combined efforts from a hepatologist, an addiction specialist, and a social worker whose shared goal is to “get you feeling better to get you healthier.”

Check out the second half of the discussion:

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use in the United States: Age Groups and Demographic Characteristics. Alcohol’s Effects on Health. 2023. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-united-states-age-groups-and-demographic-characteristics

National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Human Body. Alcohol’s Effects on Health. 2024. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-and-human-body

Cleveland Clinic. Alcohol Use Disorder. Diseases & Conditions. June 2, 2021. Accessed April 30, 2024. 

https://my.clevelandclinic.org/health/diseases/3909-alcoholism

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder (AUD) in the United States: Age Groups and Demographic Characteristics. Alcohol’s Effects on Health. 2023. Accessed April 30, 2024. 

https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics

In the first segment of this HCPLive special report, experts discuss the stigma surrounding alcohol use disorder and alcohol-associated liver disease.