Collaboration and Innovation in MASH Management, With Allysa Saggese, NP

Metabolic dysfunction–associated steatohepatitis (MASH) remains a pressing concern in hepatology, presenting substantial risks of progression to advanced liver disease, cancer, and the need for transplantation.

Communicating this reality effectively to patients is a key step in care. Clear discussions about what fatty liver and fibrosis mean, and why they matter, help patients understand both the risks and the importance of early intervention, as explained by Allysa Saggese, NP, a nurse practitioner at Weill Cornell, at the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference.

Check out part 1 of the interview here.

Lifestyle measures continue to be the cornerstone of management, with diet, physical activity, and weight management forming the foundation of care even as pharmacologic options expand. Saggese emphasizes how framing these conversations in approachable ways, using terms like “activity” instead of “exercise” and emphasizing weight management rather than strict weight loss, can help make treatment goals more realistic and patient-centered.

“I talked a lot about the word choices I use and the way I describe the non-pharm bits to my patients, and making sure that's a collaborative relationship that I think comes from sitting down and just paying attention to what they're saying to you and trying to understand what you can do with what they've just told you,” Saggese explained.

On the pharmacologic front, the MASH treatment landscape is evolving, with 2 therapies now approved by the US Food and Drug Administration in the forms of resmetirom and semaglutide. With no strict sequencing guidelines, Saggese says clinicians and patients must work together to choose the therapy that best fits individual needs, preferences, and care plans.

“Some of the biggest gaps [we still see] in MASH care is identifying these patients. I think the base knowledge for other providers who aren't in the specialty can still be improved upon,” she said, explaining the importance of knowing things like how fibrosis can progress even when liver enzymes are normal.

While they may not have the nuanced expertise of hepatology specialists, Saggese says primary care providers can serve as a hub for identifying at-risk patients and directing them to advanced care. Better dissemination of guidelines around who to screen, when, and why could help bridge this gap.

Looking ahead, Saggese expresses excitement about having more therapies to offer patients in the future, explaining how this helps them feel like they have more control over outcomes, side effects, and treatment administration.

“I'm also excited for the better efficacy as we see things come out of trials and improve upon the last trial and improve upon the last drug, just getting better and better,” she said.

References

1. Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed September 10, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

2. Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed September 10, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash