Liver disease is the area where these drugs face genuine competition from a different mechanism entirely, and this analysis puts them side by side [1]. The way to read it is categorical rather than ordinal. The cost side of MASH treatment is in what a fatty liver costs a year.
Six interventions separated from placebo. Resmetirom, which is not a GLP-1 drug at all but a thyroid hormone receptor agonist, cleared it at both doses (risk ratios 2.56 and 3.07). Survodutide 6 mg cleared it at 7.25 (95% CI 2.07 to 25.36). Tirzepatide cleared it at all three doses, from 4.29 to 6.00. That grouping is the finding worth carrying, and it sits alongside the organ comparisons in the pooled kidney outcomes.
Two of the six are not things a reader can buy. Survodutide, which tops the table, is investigational and not approved anywhere — the mediation analysis of its liver effects is on this site’s sister publication. Tirzepatide is available but not licensed for this indication in most places, so obtaining it for a liver reason means an off-label conversation.
Resmetirom deserves its own note precisely because it is not in this drug class. A reader arriving at a GLP-1 desk with a liver diagnosis should know that the drug specifically approved for their condition works through a different mechanism, and appears in this analysis with the narrowest confidence intervals of the six — 1.09 to 6.02 and 1.31 to 7.16, still wide but less so than the rest.
The practical translation is that several things work and nobody can yet say which works best. That is a more useful conclusion than a ranking, and it points the decision back to cost, route, tolerability and what a prescriber will actually write — the factors weighed in is a GLP-1 worth what it costs and the MASH screening analysis.