Liver Lineup: Advances in MASH, PSC, and PBC Care at EASL 2025

In this episode of Liver Lineup: Updates & Unfiltered Insights, hosts Kimberly Brown, MD, a professor of Medicine at Michigan State University and Wayne State University, associate medical director of the Henry Ford Hospital Transplant Institute, and medical director of Transplant Outreach Services at Henry Ford Hospital, and Nancy Reau, MD, a professor of internal medicine, the Richard B. Capps Chair of Hepatology, associate director of solid organ transplantation, and the section chief of hepatology at Rush University Medical Center, continue their discussion on notable abstracts presented at the 2025 European Association for the Study of the Liver (EASL) Congress.

Check out part 1 of Liver Lineup’s EASL recap here!

The hosts highlight an additional 3 abstracts of note from the meeting, starting with findings from the LITMUS study, a multicenter effort to identify noninvasive biomarkers that can accurately stage patients with at-risk metabolic dysfunction-associated steatohepatitis (MASH), particularly for inclusion in clinical trials. While many patients had baseline imaging and biomarker data correlated with liver biopsy, only the NIS4-2 test—a proprietary combination of 2 biomarkers—showed promise in identifying this “at-risk” group, though both hosts note that it is not yet commercially available.

Results showed widely used measures such as FIB-4 and VCTE alone underperformed for early-stage disease, to which Brown and Reau both express disappointment that reliable, accessible tools for frontline providers are still lacking—creating barriers to early referral and trial enrollment.

Shifting to primary sclerosing cholangitis (PSC), the hosts discuss a promising interim analysis of an ongoing norursodeoxycholic acid trial. At week 96, results showed the bile acid therapy significantly reduced alkaline phosphatase levels compared to placebo, particularly in patients not receiving ursodeoxycholic acid. Notably, the hosts point out 25% of treated patients showed an improvement in fibrosis stage, and fewer progressed compared to placebo. Although early, Brown says the results suggest this agent may offer hope for a disease that currently has no approved therapy and a high risk of complications like cholangiocarcinoma.

Finally, Brown and Reau review a presentation on seladelpar, a newly approved PPAR agonist for the treatment of primary biliary cholangitis (PBC). In the study, investigators used the GLOBE score—a validated tool predicting transplant-free survival—to assess outcomes and found patients on seladelpar had significantly improved GLOBE scores, reinforcing the long-term benefit of the drug beyond surrogate markers like ALP and bilirubin. While both hosts admit they do not routinely calculate the score in clinical practice, they emphasize its value in post-marketing evaluation, especially given the challenges of proving outcome benefit in a slowly progressive disease like PBC.

Reau concludes the episode with optimism about the progress being made for PBC and hope that similar breakthroughs for PSC, alcohol-associated liver disease, and MASLD are on the horizon.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.