Resmetirom Lipid Benefits and Real-World Liver Outcomes: Meena Bansal, MD

Resmetirom (Rezdiffra) reduced atherogenic lipids, including lipoprotein(a) [Lp(a)], in patients with metabolic dysfunction-associated steatohepatitis (MASH) regardless of baseline statin use, according to a secondary analysis of the phase 3 MAESTRO-NASH trial presented at AASLD The Liver Meeting 2026.¹ A separate real-world analysis of nearly 4900 patients showed improvements in liver enzymes and noninvasive measures of fibrosis and steatosis within 12 months of starting resmetirom.²

Meena Bansal, MD, of the Icahn School of Medicine at Mount Sinai, presented both analyses and discussed them in an interview with HCPLive. She emphasized cardiovascular risk should factor into every MASH treatment strategy.

“The number one cause of death is cardiovascular,” Bansal said.

How Does Resmetirom Affect Cardiovascular Risk Markers in MASH?

Approximately half (49%; n = 473) of MAESTRO-NASH participants were taking statins at baseline, and these patients more often had diabetes (79.5% vs 55.0%) and F3 fibrosis (64.3% vs 56.6%) than those not taking statins.¹ The dual primary histologic endpoints remained directionally consistent with the overall trial and nominally significant for resmetirom 80 mg and 100 mg versus placebo in both subgroups.1,3

At Week 24, resmetirom produced placebo-corrected reductions in LDL cholesterol, apolipoprotein B, triglycerides, and Lp(a) across statin and nonstatin subgroups. Among statin users with baseline LDL cholesterol of 70 mg/dL or higher, 44.4% reached less than 70 mg/dL with resmetirom 100 mg. Among those with elevated Lp(a), 36.3% and 37.5% shifted below the 30 mg/dL and 50 mg/dL thresholds, respectively, and patients in the highest baseline Lp(a) quartile had significant reductions independent of statin use.¹

Bansal noted many patients with MASH are undertreated with statins, as clinicians often hesitate to start them in patients with abnormal liver enzymes, and hepatologists frequently provide the reassurance needed to begin therapy. She highlighted Lp(a) as an emerging cardiovascular risk factor unaffected by statins, while noting cardiovascular outcomes with resmetirom have not been studied.

“Could there also be cardiovascular benefit? Not yet proven, but tantalizing,” she said.

What Does Real-World Resmetirom Use Look Like?

The real-world cohort used deidentified Trio Health electronic medical record data from 4886 adults initiating resmetirom between March 2024 and January 2026.² Patients had a mean age of 59.1 years, 60.3% were female, and common comorbidities included type 2 diabetes (45%), obesity (53.9%), and hypertension (61.8%). Glucagon-like peptide-1 receptor agonist use was 28.4% at baseline.²

Among patients with paired data at 6 and 12 months, 40.6% and 45.8% achieved an alanine aminotransferase reduction of at least 20%, and 43.4% and 54% had a controlled attenuation parameter reduction of at least 40 dB/m.² Liver stiffness fell by at least 25% in 36.5% and 45.5% of patients, and among 128 patients with fibrosis scores at baseline and 12 months, 36.7% improved by at least 1 stage.²

Bansal said the real-world population closely mirrored the clinical trial population, and she described resmetirom as easy to prescribe, with side effects typically resolving by Week 12 and no significant new safety signals emerging. The authors noted longer follow-up and analyses accounting for missing paired data are needed.² Bansal added full approval for resmetirom and semaglutide 2.4 mg will depend on outcomes data.

References

1. Bansal M, Taub R, Labriola D, et al. Reducing CV risk in patients with metabolic dysfunction-associated steatohepatitis independent of baseline based on Lp(a) and LDL lowering by resmetirom. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.

2. Bansal M, McEwen I, Parrinello C, et al. Real-world characteristics, treatment patterns, and clinical outcomes among patients with MASH initiating resmetirom. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.

3. Harrison SA, Bedossa P, Guy CD, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. doi:10.1056/NEJMoa2309000