Hepatic steatosis: what the MASH trial evidence supports posts 61–84

Post #59 and I disagree about the size of the effect, not about the direction.

Hepatic steatosis and MASH: a phase 2 trial in semaglutide for steatohepatitis showed resolution was more frequent on treatment. Histological resolution is a surrogate for long-term clinical outcomes like cirrhosis.

Taking post #59 at face value and following it one step further.

The failure mode on hepatic steatosis is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.

Hepatic steatosis is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.

Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist.

I would want to see it done twice before believing it once.

Practical answer on hepatic steatosis, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not.

This follows post #63 rather than contradicting it.

I have no financial interest in anything named in this thread and I want to say so before I comment on hepatic steatosis, because it is the sort of subject where it matters.

A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.

Where I would look next, rather than where I would stop.

The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about.

That is what the documentation says. What happens in practice is usually close.

Counterpoint on hepatic steatosis, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.

This follows post #70 rather than contradicting it.

A definition problem is doing most of the work in this hepatic steatosis discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.

Worth separating two things that post #69 runs together.

Obstructive sleep apnoea: SURMOUNT-OSA used an objective endpoint, the apnoea-hypopnoea index. Reduction was substantial. Whether the benefit is weight loss or a direct drug effect is not resolved by the trial.

Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.

The short answer was in the first line; everything after is the working.

What I would check first on hepatic steatosis is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.