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Abstract Incretin-based therapy is now central to treating metabolic dysfunction-associated steatohepatitis (MASH), but the benefit is uneven. In the ESSENCE trial, semaglutide resolved steatohepatitis without worsening fibrosis in 62.9% of patients; placebo did so in 34.3%. No one can yet tell in advance which patient will respond. Weight loss explains most of the difference between trials, but it cannot be prescribed.
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