# Semaglutide for MASH in Japanese Patients: The ESSENCE Subgroup | This GLP In 116 Japanese ESSENCE participants, steatohepatitis resolved in 63.1% against 36.8% on placebo, while the fibrosis endpoint gave 7.07 points, 95% CI −11.48 to 25.62. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/semaglutide-liver-japanese-subgroup Updated: 2026-09-18 Published: 2026-09-16 [← Research](https://thisglp.com/research) Evidence # Semaglutide for MASH in Japanese Patients: The ESSENCE Subgroup Semaglutide resolved liver inflammation in 116 Japanese trial participants. On fibrosis, the endpoint the approval is written around, the interval ran from −11 to +26. [This GLP Editorial Team](https://thisglp.com/about)September 20267 min readUpdated September 2026 116 Japanese participants: 78 on semaglutide, 38 on placebo · steatohepatitis resolved · 63.1% drug · 36.8% placebo · +26.65 (7.43 to 45.86) · fibrosis improved · 36.5% drug · 28.9% placebo · +7.07 (−11.48 to 25.62) · Differences in percentage points. The second interval crosses zero. **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 - 116 Japanese participants from the first 800 randomized in the ESSENCE trial: 78 on semaglutide, 38 on placebo. - Steatohepatitis resolved without worsening fibrosis in 63.1% against 36.8% — a difference of 26.65 points, 95% CI 7.43 to 45.86. - Fibrosis improved without worsening steatohepatitis in 36.5% against 28.9% — 7.07 points, 95% CI −11.48 to 25.62. - That second interval crosses zero, so the fibrosis endpoint did not separate in this subgroup. - The Japanese participants were older with a lower body mass index than the overall trial population. Two endpoints, two very different results, and the one that did not hold is the one the drug’s liver approval is written around — which makes the order they are read in the whole of what this page has to get right, since [the indication is defined by a fibrosis stage](https://thisglp.com/research/who-qualifies-for-semaglutide-for-liver-disease). ## What this is A subgroup analysis. Of the first 800 people randomized in the interim efficacy analysis of the ESSENCE trial, 116 were Japanese — 78 given semaglutide and 38 given placebo. [\[1\]](https://thisglp.com/research/semaglutide-liver-japanese-subgroup#ref-1) They were older and lighter than the trial population as a whole. That difference is why somebody looked, and it is also why the numbers should not be carried far. A subgroup is not designed to answer a question; it is a slice reported after the fact, and 38 people in a placebo arm is a narrow base for a proportion. ## The endpoint that separated Resolution of steatohepatitis with no worsening of fibrosis reached 63.1% on semaglutide against 36.8% on placebo. The estimated difference in responder proportions is 26.65 percentage points, 95% CI 7.43 to 45.86. That is a wide interval around a large effect, which is what a subgroup of this size produces, and it clears zero comfortably — unlike [the intervals that do not](https://thisglp.com/research/do-glp1-drugs-cause-arrhythmia). And the endpoint that did not Improvement in fibrosis with no worsening of steatohepatitis reached 36.5% against 28.9% — a difference of 7.07 points, 95% CI −11.48 to 25.62. That interval starts below zero, meaning the data are compatible with semaglutide doing slightly worse than placebo here, and it ends at 25.62, meaning they are equally compatible with a large benefit. In 116 people, this endpoint simply was not answered. ## What “directionally consistent” means That is the authors’ phrase for the whole comparison, and it is well chosen. Both point estimates favor the drug, and both are consistent with the overall trial. It is not a claim that the subgroup confirmed anything. A subgroup that agrees in direction with a larger trial adds reassurance about generalizability and does not independently establish an effect — the difference between [not detecting a difference and showing there is none](https://thisglp.com/research/does-a-glp1-affect-surgery-outcomes), applied to a slice rather than a whole study. ## Why it is worth reading anyway Because trial populations are rarely the population buying the drug, and a subgroup that differs on age and body size is a small test of whether the result travels. Here it traveled on one endpoint and was untested on the other. That is a more useful summary than either the headline or the caveat alone, and it is the same reading that [the main liver evidence](https://thisglp.com/research/semaglutide-and-liver-disease) deserves — a drug with a real effect on inflammation whose effect on scarring is the harder, slower, less settled question. ## Frequently asked Did semaglutide work in this subgroup? On steatohepatitis resolution, yes — 63.1% against 36.8%, a difference of 26.65 points with a confidence interval clear of zero. On fibrosis improvement the interval ran from −11.48 to 25.62 and did not separate. How many people were in it? 116 — 78 on semaglutide and 38 on placebo — drawn from the first 800 randomized in an interim analysis. What does 'directionally consistent' mean? That both estimates favored the drug and agreed with the overall trial. It is not a claim that the subgroup independently confirmed the effect. Why look at Japanese participants separately? They were older and had a lower body mass index than the overall trial population, which makes them a small test of whether the result travels across body size and age. ## Sources 1. \[1\] Nakajima A, et al. (2026). Semaglutide in Japanese participants with metabolic dysfunction-associated steatohepatitis: a subgroup analysis of the ESSENCE trial Journal of Gastroenterology. [PMID 42663669](https://pubmed.ncbi.nlm.nih.gov/42663669/) ## 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. [Compare providers →](https://thisglp.com/best/compounded-semaglutide) ## More in Evidence - [ 150 minutes · Weekly activity goal · 2 days · Muscle strengthening · Adapt · Symptoms and ability ### Exercise on Ozempic: Building Strength Without Ignoring Symptoms ](https://thisglp.com/research/exercise-on-ozempic) - [ STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower. ### Does Ozempic Lower Cholesterol? 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