# Does Semaglutide Help Liver Cirrhosis? Not in the Trial That Tested It | This GLP Does semaglutide help liver cirrhosis? In the cirrhosis trial, fibrosis improved in 11% on the drug vs 29% on placebo | cohort benefits appear earlier. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/does-semaglutide-help-liver-cirrhosis Updated: 2026-09-18 Published: 2026-09-17 [← Research](https://thisglp.com/research) Evidence # Does Semaglutide Help Liver Cirrhosis? Not in the Trial That Tested It In 71 people with MASH cirrhosis, fibrosis improved in 11% on semaglutide and 29% on placebo. A larger 2026 trial mixed in earlier stages, and two cohorts disagree on what happens after cirrhosis. [This GLP Editorial Team](https://thisglp.com/about)September 20267 min readUpdated September 2026 Fibrosis improved by one stage or more · 2023 trial, cirrhosis only · 71 people, 48 weeks · semaglutide · 11% · placebo · 29% · 2026 trial, F2 to F4c · 200 in these two arms, 52 weeks · semaglutide · 30% · placebo · 16% · Of the two, only the 2023 trial was limited to cirrhosis. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - In a 71-person trial limited to MASH cirrhosis, fibrosis improved in 11% on semaglutide 2.4 mg against 29% on placebo after 48 weeks. The difference was not significant. - A 2026 trial of 698 people with fibrosis stages F2 to F4c found semaglutide alone improved fibrosis in 30% against 16%. The authors call that nominally significant, and it was not the primary comparison. - In a large veterans cohort, GLP-1 use was linked to less progression to cirrhosis, hazard ratio 0.86. No association appeared in people who already had cirrhosis. - A single-center cohort found less hepatic encephalopathy in GLP-1 users with cirrhosis, but more among those who also had liver cancer. - The US approval for semaglutide in liver disease covers stages F2 to F3, without cirrhosis. Not in the trial that tested it. In 71 people with compensated MASH cirrhosis, semaglutide 2.4 mg did not improve liver scarring over 48 weeks [\[1\]](https://thisglp.com/research/does-semaglutide-help-liver-cirrhosis#ref-1). Fibrosis improved in 11% on the drug and 29% on placebo, a difference that was not significant. The approved use stops at stage F3, before cirrhosis, as [the liver disease eligibility guide](https://thisglp.com/research/who-qualifies-for-semaglutide-for-liver-disease) sets out. The broader question of liver safety is covered in [whether GLP-1 drugs are bad for the liver](https://thisglp.com/research/are-glp1-drugs-bad-for-your-liver). This page covers the last stage of the disease only. ## The cirrhosis trial The trial enrolled adults with biopsy-confirmed MASH cirrhosis and a BMI of 27 or more. Seventy-five percent had diabetes. They were randomized 2:1, 47 to semaglutide 2.4 mg weekly and 24 to placebo. The primary endpoint was fibrosis improving by at least one stage without the steatohepatitis worsening. That happened in 5 of 47 on semaglutide and 7 of 24 on placebo. The odds ratio was 0.28, with a 95% confidence interval from 0.06 to 1.24. Resolution of steatohepatitis did not differ either. With 71 people, the trial could miss a modest benefit. Safety held within the trial. There were no decompensating events or deaths, and liver and kidney function stayed stable. Nausea affected 45% on semaglutide against 17% on placebo, and vomiting 17% against none. ## The 2026 trial that included cirrhosis A larger phase 2 trial enrolled 698 people with MASH and fibrosis from stage F2 to compensated cirrhosis [\[2\]](https://thisglp.com/research/does-semaglutide-help-liver-cirrhosis#ref-2). Its main question was whether adding zalfermin to semaglutide helped, and it did not. Zalfermin 30 mg plus semaglutide improved fibrosis in 24% against 16% on placebo, p = 0.19. Semaglutide 2.4 mg alone reached 30% against 16% at 52 weeks. The authors describe that as nominally significant, p = 0.024, and it sat outside the protected primary comparison. A cagrilintide plus semaglutide arm did not differ substantially from placebo, which matters for [the CagriSema comparison](https://thisglp.com/research/is-cagrisema-better-than-semaglutide). The 30% is not a cirrhosis result The trial mixed stages F2, F3 and compensated cirrhosis. Its abstract does not report the cirrhosis group separately. The authors say only that semaglutide might merit further testing in that group. Gastrointestinal events affected 73% on semaglutide against 51% on placebo. ## What the cohorts add A US veterans cohort compared GLP-1 drugs with DPP-4 inhibitors in people with fatty liver disease and diabetes [\[3\]](https://thisglp.com/research/does-semaglutide-help-liver-cirrhosis#ref-3). In 14,606 users without cirrhosis, progression to cirrhosis ran 9.98 against 11.10 events per 1,000 person-years. The hazard ratio was 0.86. In 1,452 users who already had cirrhosis, no association appeared with any outcome. The authors read that as a case for treating earlier in the disease. Why scarring can respond differently from liver fat is examined in [the survodutide mediation analysis](https://thisglp.com/research/liver-repair-that-was-not-the-weight). A single-center cohort looked at hepatic encephalopathy, a brain complication of advanced liver disease [\[4\]](https://thisglp.com/research/does-semaglutide-help-liver-cirrhosis#ref-4). Of 2,557 people with cirrhosis, 139 took a weight-loss dose for six months or more. They developed it less often, 3.6% against 18.7%, with an adjusted hazard ratio of 0.33, P = 0.048. The direction reversed in people who also had liver cancer, where the hazard ratio was 6.12, P = 0.024. The absolute cancer risk on these drugs is set out in [the liver cancer cohort](https://thisglp.com/research/glp1-liver-cancer-absolute-risk). ## What is not yet known Neither trial showed semaglutide reversing scarring once cirrhosis was present. Decompensated cirrhosis was excluded from both trials, so it is not measured. The encephalopathy finding comes from 139 treated people at one center. The earlier-stage evidence, where results are stronger, sits in [the phase 3 liver trial](https://thisglp.com/research/semaglutide-and-liver-disease). ## Frequently asked Does semaglutide help liver cirrhosis? It has not been shown to. In a 48-week trial of 71 people with MASH cirrhosis, fibrosis improved in 11% on semaglutide 2.4 mg and 29% on placebo, not a significant difference. Is semaglutide approved for cirrhosis? No. The US approval for semaglutide in MASH covers fibrosis stages F2 to F3, without cirrhosis. Can semaglutide prevent cirrhosis? A veterans cohort with fatty liver disease and diabetes found less progression to cirrhosis on GLP-1 drugs than on DPP-4 inhibitors, hazard ratio 0.86. That is an association, not a trial result. Does a GLP-1 reduce hepatic encephalopathy? One single-center cohort found it less often in 139 users with cirrhosis, 3.6% against 18.7%. Among people who also had liver cancer, the risk was higher, hazard ratio 6.12. Is semaglutide safe in cirrhosis? In the 71-person trial of compensated cirrhosis there were no decompensating events or deaths, and liver and kidney function stayed stable. Nausea affected 45% on the drug against 17% on placebo. ## Sources 1. \[1\] Loomba R, Abdelmalek MF, Armstrong MJ, Jara M, Kjær MS, Krarup N, et al. (2023). Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial The Lancet Gastroenterology & Hepatology. [PMID 36934740](https://pubmed.ncbi.nlm.nih.gov/36934740/) 2. \[2\] Loomba R, George J, Castera L, Francque S, Lawitz E, Shoeb A (2026). Efficacy and safety of zalfermin co-administered with semaglutide in participants with fibrosis and cirrhosis due to metabolic dysfunction-associated steatohepatitis: a phase 2, dose-ranging, double-blind, randomised controlled trial The Lancet Gastroenterology & Hepatology. [PMID 42456707](https://pubmed.ncbi.nlm.nih.gov/42456707/) 3. \[3\] Kanwal F, Kramer JR, Li L, Yang YX, Cao Y, Yu X, et al. (2024). GLP-1 Receptor Agonists and Risk for Cirrhosis and Related Complications in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease JAMA Internal Medicine. [PMID 39283612](https://pubmed.ncbi.nlm.nih.gov/39283612/) 4. \[4\] Singh V, Wang M, Ebinger J, Velazquez A, Cheng S, Kwan AC, et al. (2026). Glucagon-Like Peptide 1 Receptor Agonists are Associated With Reduced Risk of Hepatic Encephalopathy in Cirrhosis Journal of Clinical Gastroenterology. [PMID 42183591](https://pubmed.ncbi.nlm.nih.gov/42183591/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. 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