For patients with mixed metabolic- and alcohol-associated liver disease (or ongoing moderate alcohol use) who otherwise meet presumed F2–F3 criteria by NITs, how do you operationalize initiation and monitoring of a GLP-1 receptor agonist, particularly how you interpret NIT trends when alcohol intake (and inflammation) may be changing during treatment?

In patients with MetALD, I’ll initiate a GLP‑1 RA once F2-F3 risk is supported by concordant NITs, but only after establishing a stable baseline that includes recent alcohol intake and inflammatory markers (e.g., GGT). For monitoring, I interpret NIT trends cautiously. Early improvements (<6M) in VCTE or ELF often reflect reductions in inflammation or alcohol use rather than fibrosis change. I therefore anchor decisions on longitudinal consistency across modalities and clinical context rather than single timepoint shifts. If alcohol intake is fluctuating, I prioritize behavioral stabilization and reassess trajectory before attributing benefit to the drug. For ALD, I do not routinely prescribe GLP-1RA unless there are other metabolic risk fa...