For patients with obesity and high cardiometabolic risk whose VCTE liver stiffness is borderline (about 8–10 kPa), what is your preferred tie-breaker to justify initiating MASH-directed pharmacotherapy: ELF, a second serum fibrosis panel, repeat VCTE after weight stability, or MR-based fibrosis assessment when available?

A GLP1a would offer benefits to this patient, who is obese, at high risk for cardiometabolic diseases (particularly if the risk is cardiovascular or insulin resistance), and has early possible fibrosis caused by MASH, as evidenced by mildly abnormal VCTE measurements.

The indication would not be based on level 1A evidence, and the patient should be advised of this, particularly in the event they lack GLP1a insurance coverage and must self-pay.

Success and response would be measured by reduction ...