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Beyond Initial Response

CE / CME

Beyond Initial Response: Long-term Monitoring and Management in MASH

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Released: July 14, 2025

Expiration: July 13, 2026

Kathleen Corey
Kathleen Corey, MD, MPH, MMSc
CME/CE Information

Activity

Progress
1 2
Course Completed

Patient History: Recap From Case 1  
Daniel Rodgers is a 54-year-old man with class I obesity (BMI 34.1 kg/m²), T2D, hypertension, and hyperlipidemia. He drinks minimal alcohol and has a maternal history of cirrhosis presumed to be metabolic dysfunction–associated steatotic liver disease related. His medications include metformin, lisinopril, and atorvastatin. Initial labs showed elevated alanine aminotransferase (ALT) (52 U/L), aspartate aminotransferase (AST) (48 U/L), A1C of 7.8%, platelets 165,000/µL, and normal albumin. VCTE revealed liver stiffness of 10.2 kPa and controlled attenuation parameter 312 dB/m, consistent with F2-F3 fibrosis and moderate to severe steatosis, confirming MASH. 

Part 1 Summary 
Mr Rodgers began a structured lifestyle program and was started on incretin-based therapy to support weight loss and metabolic control. At 6 months, he lost 11% of body weight, improved his A1C to 6.8%, and saw liver stiffness drop to 7.5 kPa on VCTE. These improvements reflect effective noninvasive, guideline-based management. A long-term plan was implemented with annual VCTE and regular cardiometabolic monitoring. 

Twelve months after initiating therapy, Mr Rodgers continues to maintain a weight loss of approximately 11% and good glycemic control (A1C of 6.6%). He now weighs 211.8 lbs (BMI is 30.3 kg/m²). Mr Rodgers remains physically active and adherent to his diet and pharmacotherapy and denies hypoglycemia or adverse effects. However, at a routine follow-up visit, he expresses concern about long-term medication use and whether ongoing pharmacologic treatment is necessary now that he feels “normal.” 


You consider whether continuing incretin-based therapy is still appropriate and how to best personalize his long-term management plan. 

What is the most appropriate next step in managing Mr Rodgers’ pharmacologic therapy?