CSP Exam Prep Course: Metabolic Dysfunction-Associated Steatohepatitis (MASH)

Vocabulary flashcards covering the pathophysiology, non-invasive diagnostic criteria, pharmacologic treatments, dosing, and clinical pipeline for Metabolic Dysfunction-Associated Steatohepatitis (MASH) from the NASP 2025 CSP Exam Prep Course.

Metabolic Dysfunction-Associated Steatohepatitis (MASH)

The updated medical nomenclature replacing non-alcoholic steatohepatitis (NASH) that emphasizes the critical role of metabolic dysfunction in both metabolic dysfunction-associated steatotic liver disease (MASLD) and its more severe, inflammatory form.

Histological Hallmarks of MASH

The three diagnostic microscopic features of MASH: hepatic steatosis resulting from microvascular accumulation and storage of triglycerides in hepatocytes, local inflammation, and hepatocyte ballooning.

Leading Causes of Mortality in MASH

Cardiovascular disease is the primary cause of death in early stages of MASH, whereas liver-related morbidity and mortality become more prevalent once patients advance to fibrosis stages F3 to F4.

Metabolic Syndrome Diagnostic Thresholds in MASH

Clinical indicators comprising abdominal obesity (waist circumference $> 40\,\text{inches}$ in men; $> 35\,\text{inches}$ in women), triglycerides $\ge 150\,\text{mg/dL}$, HDL-C ($< 40\,\text{mg/dL}$ in men; $< 50\,\text{mg/dL}$ in women), blood pressure $\ge 130/85\,\text{mm Hg}$, and fasting glucose $\ge 100\,\text{mg/dL}$.

FIB-4 Score Cutoff Adjustment for Older Adults

An updated diagnostic rule-out threshold raised to $\text{FIB-4} < 2.0$ specifically for adults aged $\ge 65\,\text{years}$.

EASL-EASD-EASO 2024 Referral Thresholds

Clinical guideline cutoffs directing patients with $\text{FIB-4} \ge 2.67$ or vibration-controlled transient elastography (VCTE) $\ge 8\,\text{kPa}$ to hepatology care for advanced fibrosis assessment.

Rezdiffra (resmetirom)

A thyroid hormone receptor-beta (THR-beta) agonist granted accelerated approval for use alongside diet and exercise to treat noncirrhotic NASH/MASH in adults with moderate to advanced liver fibrosis (stages F2 to F3).

Rezdiffra Weight-Based Dosing

An oral once-daily dosing regimen taken with or without food: $80\,\text{mg}$ daily for patients weighing $< 100\,\text{kg}$, and $100\,\text{mg}$ daily for patients weighing $\ge 100\,\text{kg}$.

Rezdiffra Statin Dose Restrictions

Daily statin caps required when co-administered with resmetirom: rosuvastatin $\le 20\,\text{mg}$, simvastatin $\le 20\,\text{mg}$, pravastatin $\le 40\,\text{mg}$, and atorvastatin $\le 40\,\text{mg}$.

Rezdiffra Hepatic Impairment Precaution

A safety instruction to avoid resmetirom use in patients with moderate to severe hepatic impairment classified as Child-Pugh Class B or C.

Rezdiffra Monitoring Parameters

Recommended assessments including hepatic function panel, noninvasive liver stiffness measurement, and MRI-PDFF for efficacy tracking, along with thyroid function and lipid panels for safety.

Wegovy (semaglutide)

A glucagon-like peptide 1 (GLP-1) receptor agonist administered subcutaneously once weekly, indicated for chronic weight management, major adverse cardiovascular event (MACE) risk reduction, and FDA-indicated under accelerated approval for non-cirrhotic MASH with F2–F3 fibrosis.

Saxenda (liraglutide)

A daily subcutaneous glucagon-like peptide 1 (GLP-1) receptor agonist initiated at $0.6\,\text{mg}$ daily and titrated weekly to a maintenance dose of $3\,\text{mg}$ for chronic weight management; it is strictly contraindicated in pregnancy.

Zepbound (tirzepatide)

A dual glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist administered subcutaneously once weekly for chronic weight management and moderate to severe obstructive sleep apnea (OSA) in adults with obesity.

Incretin-Based Therapy Boxed Warning

A black box warning regarding the risk of thyroid C-cell tumors, making these agents contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Zepbound Oral Contraceptive Interaction

A clinical recommendation directing females taking oral contraceptives to switch to a non-oral method or add barrier contraception for $4\,\text{weeks}$ after drug initiation and for $4\,\text{weeks}$ following each dose escalation.

Lanifibranor

A pan-peroxisome proliferator-activated receptor (Pan-PPAR) agonist under evaluation in Phase 3 clinical trials for the treatment of MASH.

Efruxifermin and Pegozafermin

Fibroblast growth factor 21 receptor agonists (FGF21 RAs) currently in Phase 3 clinical trials for MASH management.

Denifanstat

A fatty acid synthase (FASN) inhibitor being evaluated in Phase 2 clinical trials for the treatment of MASH.

Saroglitazar

A dual PPAR $\alpha/\gamma$ agonist being investigated in Phase 2b clinical trials for MASH therapy.