Wei Zhang, MD, PhD, is a transplant hepatologist at Massachusetts General Hospital and assistant professor at Harvard Medical School.

Wei Zhang, MD, PhD

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

Alcohol-Associated Liver Disease Stigma Hinders Diagnosis and Care, With Wei Zhang, MD

New research highlights the disproportionate impact of etiology-specific stigma on patients with liver disease, demonstrating heightened rates, delays in diagnosis, and barriers to care among patients with alcohol-associated liver disease (ALD) compared to those with non-alcohol-related liver disease.

Wei Zhang, MD, a transplant hepatologist and assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School, presented the findings at the 

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

. The results emphasize the need for patient-informed strategies to reduce stigma, support earlier diagnosis and intervention, and improve clinical outcomes for ALD patients.

The stigma surrounding alcohol use disorder impacts patients at all levels of their lives, including psychosocial and healthcare. As a result, alcohol-associated liver disease can complicate conversations with healthcare providers and family members, interfere with illness recognition and insight, timely help-seeking, treatment adherence, and recovery.

“Stigma is one of the main reasons patients with alcohol-associated liver disease don’t receive timely or equitable care. When patients feel judged or blamed for their illness, they are less likely to come to care early, disclose their alcohol use honestly, or stay engaged in follow-ups,” Zhang said in an interview with 

. “From a provider perspective, stigma can lead to skepticism about patient motivation and raise questions about whether patients ‘deserve’ care. This bias also lowers the threshold for denying patients with ALD access to liver transplant, while other liver disease etiologies are often considered blameless.”

Zhang and colleagues measured stigma using 3 categories: internalized, anticipated, and experienced. The Liver Disease Stigma Scale (LDSS), a 28-item validated instrument, quantified each category. Internalized stigma includes self-identified negative stereotypes and blame, anticipated stigma refers to expectations of judgment or discrimination, and experienced stigma captures real-world instances of judgment, blame, or differential treatment. These factors were assessed in family and healthcare settings.

The study included 221 adults with liver disease, including 133 with ALD and 88 with non-ALD etiologies. Patients with ALD were more likely to be male and to have lower educational attainment (

significantly greater reported levels of stigma in patients with ALD, including experienced (mean,1.75; standard deviation [SD], 0.90 vs 1.23; SD, 0.46; 

<.001), anticipated (1.57; SD, 0.77 vs 1.24; SD, 0.50; 

<.001), and internalized (2.34; SD, 1.12 vs 1.54; SD, 0.84; 

<.001). Between domains, differences were also observed in both family and healthcare settings. Family-related experienced stigma was higher in patients with ALD (1.79; SD, 1.07) compared with those with non-ALD (1.19; SD, 0.37), as was healthcare-related experienced stigma (1.71; SD, 0.93 vs 1.27; SD, 0.62).

Investigators found heightened negative attitude towards liver disease (2.11; SD,0.87 vs 1.44; SD, 0.59; 

<.001) and liver disease treatment (1.38; SD, 0.54 vs 1.21; SD,0.39; 

= .008) in patients with ALD, underscoring stigma’s influence on perceptions of care, engagement, and healthcare outcomes.

“From a provider perspective, education is key to reduce bias and recognizing ALD as a treatable disease, and it's important for providers to feel comfortable prescribing appropriate medications. Providers should also use patient-centered language to make patients feel heard and engaged,” said Zhang. “At the system level, we can implement more objective selection processes for interventions and liver transplant to reduce personal bias. Integrated hepatology-addiction clinics can also provide the comprehensive care these patients need.”

Editor’s note: Zhang reports no relevant disclosures.

Zhang W, Hsu K, Wu E, et al. Greater liver disease–related stigma among patients with alcohol-associated liver disease compared with non–alcohol-related liver disease. Abstract presented at: American Association for the Study of Liver Diseases The Liver Meeting 2025; 2025; Washington, DC.

Schomerus G, Leonhard A, Manthey J, et al. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol. 2022;77(2). doi:10.1016/j.jhep.2022.04.026

Videos

A study presented at AASLD 2025 shows patients with alcohol-associated liver disease experience greater stigma compared with non-ALD patients.


Preventing Alcohol Relapse After Liver Transplant, with Wei Zhang, MD, PhD

 presents a persistent challenge in liver transplantation for patients with 

, with relapse remaining a significant risk even after a successful procedure.

Despite the complexity of managing post-transplant alcohol use—compounded by psychiatric comorbidities, social instability, and stigma—innovative care models are emerging to address these gaps, one of which was presented at Digestive Disease Week (DDW) 2025 by Wei Zhang, MD, PhD, a transplant hepatologist at Massachusetts General Hospital and assistant professor at Harvard Medical School.

In December 2022, he and a group of colleagues from Massachussetts General Hospital established the Long-term Individualized Follow-up after Transplant (LIFT) Clinic, a multidisciplinary program involving a hepatologist, a psychiatrist, a social worker, and a case manager to assist in the prevention and management of alcohol relapse in high-risk liver transplant recipients.

Of 41 pts with <2 years’ sobriety at time of liver transplant referred for relapse prevention, 17 (41.5%) attended the clinic, with the initial visit at a mean 8.4 months post-transplant. The clinic connected patients with medications for alcohol use disorder and helped to engage patients in behavioral addiction services. Of note, none of the 17 high-risk patients who attended the clinic for prevention had alcohol relapse during the study follow up period.

“We try to prevent them from relapsing, because once they relapse, they lose some of the incentives after transplant because they already got a transplant,” Zhang explained to 

. “Even if they have relapsed, if we're able to earn their trust, they will be able to get engaged in the care. Obviously we want them to stay stay sober, but sometimes they struggle with this, so we aim to address how they can reduce their drinking, instead of completely stopping.”

Of 38 post-tranaplant patients referred after initial relapse, 21 (55.3%) attended, with the first visit at mean 39 months post-transplant. Medications for alcohol use disorder were started post-relapse in more than 70% of patients, and more than half were connected to behavioral services. While 8 patients continued to drink alcohol, 5 had sustained sobriety >6 months and 8 meaningfully reduced alcohol use.

Loking ahead, Zhang points to the importance of being mindful of relapse in patients considered to be low risk, citing a scenario he encountered with a patient who was sober for 5 years but experienced a severe relapse. Now, the LIFT Clinic has expanded to include all patients who have alcohol as a contributing factor to their liver disease.

“If we find that they have very low risk, we could see them in a longer interval, but if we find any high risk factors in those patients, we start to follow them very closely,” he explained. “I think with this approach, we will provide even better care for those patients, regardless of their risk of relapse.”

Editors’ note: Zhang reports no relevant disclosures.

Rice B, Ivkovic A, Hsu K, et al. EVALUATING THE IMPACT OF A MULTI-DISCIPLINARY CLINIC TO PREVENT ALCOHOL RELAPSE IN HIGH-RISK PATIENTS AFTER LIVER TRANSPLANT FOR ALCOHOL-RELATED LIVER DISEASE. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

Zhang describes the importance of multidisciplinary care for preventing alcohol relapse post-transplant, citing success from Mass General’s LIFT Clinic.