How do you decide whether to initiate semaglutide for MASH when alcohol intake is near MASLD/MetALD boundary ranges or fluctuates with intermittently positive PEth—specifically, do you require a documented period of reduction/abstinence before treatment, or do you start therapy with a modified monitoring/futility framework?

Typically, my approach is to ensure that alcohol is not contributing to their liver disease before initiating anti-fibrotic therapy. I usually counsel them and monitor their PETH testing serially. Sometimes, cutting out alcohol itself will help reduce their fibrosis level over time and may obviate t...

I would not require a mandatory abstinence period before starting semaglutide if the patient otherwise qualifies (i.e., metabolic dysfunction-associated steatohepatitis [MASH] with F2/F3 fibrosis, no other contraindications to semaglutide). I would, however, treat this as metabolic and alcohol-assoc...