Fatty liver disease is the condition most likely to be sitting underneath a reader’s interest in these drugs without either of them knowing it. More than half the participants in the largest trial also had type 2 diabetes, and almost all met at least one cardiometabolic criterion [3]. It is a common disease that produces no symptoms until it produces serious ones.
What the phase 3 trial found
ESSENCE randomized 1,197 patients with biopsy-defined MASH and fibrosis at stage 2 or 3 in a 2:1 ratio to weekly semaglutide at 2.4 mg or placebo for 240 weeks. A planned interim analysis at week 72, covering the first 800 patients, reported both primary endpoints[1].
Steatohepatitis resolved without worsening of fibrosis in 62.9% of the 534 patients on semaglutide and 34.3% of the 266 on placebo, an estimated difference of 28.7 percentage points (95% CI 21.1 to 36.2). Fibrosis improved without worsening of steatohepatitis in 36.8% against 22.4%, a difference of 14.4 points (95% CI 7.5 to 21.3). Both outcomes together were reached by 32.7% against 16.1%, a difference of 16.5 points (95% CI 10.2 to 22.8).
Weight fell 10.5% on semaglutide and 2.0% on placebo. Mean changes in bodily pain scores did not differ between the groups, and gastrointestinal adverse events were more common on the drug — the same pattern the dose-escalation literature describes, which we cover in titration and nausea.
Whether the rest of the class does the same
A 2025 meta-analysis pooled 13 phase 2 and phase 3 randomized trials covering 1,811 participants [2]. Among people with MASH and moderate to advanced fibrosis, GLP-1 receptor agonists over up to 72 weeks beat placebo on MASH resolution with a pooled odds ratio of 3.48 (95% CI 2.69 to 4.51) and on fibrosis improvement at 1.79 (95% CI 1.37 to 2.35). Both pooled estimates had an I² of 0%, meaning the trials agreed with each other to an unusual degree.
Liver fat measured by magnetic resonance fell by a pooled mean of 4.50% (95% CI 6.60 to 2.40). That estimate came from nine trials with an I² of 95.9% — the studies did not agree, and the pooled number should be read as a direction rather than a quantity.
What this does and does not tell a buyer
Every figure on this page came from 2.4 mg of brand semaglutide given weekly for at least 72 weeks. That is the top of the approved escalation, held for well over a year. Most of the sellers tracked here publish an opening figure and say nothing about what the price becomes at the doses these trials ran at — the gap counted in who publishes a dose ladder and listed seller by seller in published dose ladders.
It also tells a buyer what to ask about rather than what to buy. A liver result is not something a telehealth intake form establishes, and the trials selected patients by biopsy. If you are reading this because of a scan result or an enzyme panel, the useful next step is a clinician who can see the panel, not a storefront. The wider question of what the weight trials themselves support is in what the semaglutide trials are worth, and the kidney outcome data in semaglutide and kidney disease.