When patients meet criteria for more than one MASH-directed agent class, how do you sequence versus combine therapies in someone with high cardiovascular risk but borderline hepatic severity, and what surrogate-response threshold would make you comfortable escalating to dual therapy?

In a patient with high cardiovascular (CV) risk and only borderline hepatic severity, I generally prioritize a metabolically effective agent first, such as glucagon-like peptide-1 (GLP-1)-based therapy, given the dual CV and hepatic benefit, and reassess liver response before adding liver-directed therapy. I consider sequencing over upfront combination unless there is clear evidence of progressive fibrotic risk or suboptimal metabolic response. For escalation, I look for a discordant response, f...