Liver Lineup: Unmet Needs and Evolving Standards in Alcohol-Associated Liver Disease, With Jessica Mellinger, MD

In this episode of Liver Lineup: Updates and Unfiltered Insights, hosts Nancy Reau, MD, and Kimberly Brown, MD, are joined by guest Jessica Mellinger, MD, to discuss rising prevalence, new care models, and evolving concepts in alcohol-associated liver disease (ALD).

Mellinger begins by addressing the troubling rise in alcohol use and ALD. Despite widespread healthcare engagement, she says patients with ALD are often diagnosed late, underscoring the need for proactive screening approaches that combine assessments of both liver health and alcohol use. She also notes that defined screening models and pathways developed for MASLD could be adapted for ALD to improve early identification and intervention.

A key part of the discussion centers on Mellinger’s pioneering integrated clinic model, which brings hepatology and addiction psychiatry together in a single, co-located setting. She explains that addressing liver health and alcohol use disorder alongside underlying drivers such as anxiety, depression, insomnia, and chronic pain is critical—and that siloed systems of care have historically failed these patients.

The conversation also explores the emergence of MetALD and the overlap between metabolic and alcohol-associated liver disease. Mellinger notes that while definitions continue to evolve, understanding the interplay between metabolic dysfunction and alcohol use will be essential for tailoring therapies. GLP-1 receptor agonists, already transforming the metabolic liver disease landscape with the recent FDA approval of semaglutide for MASH, are showing early promise for ALD as well, with some patients reporting reduced alcohol cravings and improved liver parameters.

Turning to transplantation, Mellinger reflects on the progress since the Dallas Criteria were introduced, highlighting shifting attitudes toward early liver transplant in carefully selected patients. She stresses the importance of moving beyond rigid sobriety thresholds toward a more patient-centered approach focused on post-transplant support and relapse management.

The trio emphasizes that progress in alcohol-associated liver disease depends on bridging the long-standing divide between hepatology and addiction medicine. With integrated care models gaining traction, evolving definitions like MetALD reshaping clinical thinking, and novel therapeutics such as GLP-1 receptor agonists offering new hope, the field may be entering a pivotal era.

Editors’ Note: 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. Relevant disclosures for Mellinger include GlaxoSmithKline.

References

1. Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed October 14, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash

2. Asrani SK, Trotter J, Lake J, et al. Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis. Liver Transpl. 2020;26(1):127-140. doi:10.1002/lt.25681