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ForumsMASH / Liver DiseaseALT normalization rates on GLP-1 — what worked for you?

ALT normalization rates on GLP-1 — what worked for you?

rick_sfbay Wed, Jan 24, 2024 at 9:58 AM 10 replies 2,156 viewsPage 1 of 2
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rick_sfbay
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Jan 2025
San Francisco, CA
Jan 24, 2024 at 9:58 AM#1

ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

The bit I cannot resolve on my own is whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is.

I would rather have one careful answer than five confident ones.

48 18mike_mealprep, NicoleRaleigh, james_edin and 45 others
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labquiet_amy
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Mar 2024
Cambridge, MA
Jan 24, 2024 at 11:07 AM#2
rick_sfbay said:
ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 331 dB/m (moderate steatosis) and stiffness 9.8 kPa (possible fibrosis). Diagnosed with NAFLD.

After 11 months: CAP dropped to 244 dB/m (minimal steatosis) and stiffness normalized to 5.2 kPa. Hepatologist says the liver is essentially healing itself as the metabolic stress resolves.

GLP-1 agonists may become first-line NASH therapy. The Phase 3 data on semaglutide for NASH is very promising.

Last edited: Jan 24, 2024 at 1:07 PM
47 17HPLC_Greg, LibrarianMeg, bri_stats and 44 others
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Dr.SleepRoch
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Jan 24, 2024 at 12:16 PM#3
labquiet_amy said:
Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 331 dB/m (moderate steatosis) and stiffness 9.8 kPa (possible…

ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase 3 ATTAIN trial. NASH resolution was achieved in ~60% of patients[1].

This is relevant to liver and MASH because survodutide's glucagon agonism specifically targets hepatic lipid metabolism — making it potentially the best-in-class agent for NASH/MAFLD comorbid with obesity.

References:
[1] Sanyal AJ, et al. N Engl J Med. 2024.
46 16Dr.NephBHM_UK, kim_atl_prep, sarah_TO and 43 others
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jennifer_SEA
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Jan 24, 2024 at 1:25 PM#4
rick_sfbay said:
ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

Adding a me-too, because a thread of one person's experience is not much use.

Last edited: Jan 24, 2024 at 7:25 PM
45 15jim_asheville, matt_MKE, Dr.ReproEndo and 42 others
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carl_compliance
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Nov 2024
Raleigh, NC
Jan 24, 2024 at 8:00 PM#5

Clinical perspective, offered as context rather than as advice.

Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 6 months on GLP-1 therapy:

MarkerBaselineCurrentNormal Range
ALT79267-56 U/L
AST622610-40 U/L
GGT89349-48 U/L
ALP1098144-147 U/L

FibroScan also improved — liver stiffness from 8.5 kPa to 5.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.

44 14dave_SLC, FDA_TrackerJim, ricardo_MIA and 41 others
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