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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

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Patient Perspective: A Peer With MASH Reflects on Mr Rodgers’ Ongoing Journey
“Listening to the next part of Mr Rodgers’ journey, I really got it. When you start feeling better and your labs are good, it’s easy to think, ‘Maybe I don’t need this medication anymore.’ I’ve thought the same thing. But the truth is that MASH doesn’t just go away. And stopping the medication too soon can send you backwards—weight comes back, sugar goes up, liver numbers start creeping again. 

“I liked how his care team didn’t panic when that happened. They just helped him get back on track. That part really hit home for me—because this isn’t about quick fixes. It’s about sticking with it. I haven’t had any real symptoms, but just knowing things are going in the right direction makes me feel better. My goal right now? I’d love to get under 200 pounds. I’m getting close, and I can do more now—bend over and move around more easily. That’s huge. Mr Rodgers’ story reminds me we’re not just treating liver numbers. We’re trying to get our lives back.” 

Case Conclusion and Discussion Summary 
This phase of Mr Rodgers’ case emphasizes the critical importance of sustained therapy and structured monitoring in the long-term management of MASH. Following his initial success with lifestyle modifications and incretin-based pharmacotherapy, Mr Rodgers entered a period of metabolic stability, maintaining 13% weight loss, normalized liver enzymes, and improved A1C. However, this stage presented a common clinical challenge: determining how to manage patients with ongoing treatment response but plateauing fibrosis improvement. Many patients like Mr Rodgers begin to question the necessity of continued pharmacologic intervention once they feel “normal.” This reflects a broader clinical practice gap in understanding that MASH is a chronic, recurring disease where remission does not equal a cure.1 Furthermore, cessation of treatment can result in regression of gains. 

Clinical evidence supports the continued use of incretin-based therapies like GLP-1 receptor agonists and tirzepatide for long-term disease control.1 These agents not only reduce weight and improve glycemic indices but also demonstrate anti-inflammatory and antifibrotic effects in the liver.2 Discontinuation of therapy in Mr Rodgers’ case could have led to weight regain, glycemic worsening, and hepatic disease progression. The decision to continue therapy and monitor with noninvasive tools like VCTE is aligned with the American Association for the Study of Liver Disease guidelines, which recommends assessment of fibrosis and metabolic parameters annually or every 2 years in low-risk patients.3 VCTE remains a cornerstone of noninvasive monitoring, especially in those with prior advanced fibrosis or comorbid T2D and obesity, by offering a safe and cost-effective alternative to routine liver biopsy. 

In addition, Mr Rogers’ case reinforces the utility of a shared-care model in the long-term management of MASH. Transitioning routine follow-up to primary care, while maintaining hepatology support, reflects a scalable and guideline-concordant strategy.3 This model ensures continuity of metabolic surveillance and timely identification of hepatic relapse, while avoiding fragmentation of care. Of more importance, it also respects patients’ autonomy and aligns care with their evolving needs, preferences, and risk profile. 

Mr Rodgers’ continued success is attributable to effective pharmacologic intervention, clear education, consistent engagement, and a long-term monitoring strategy that integrates both hepatic and cardiometabolic health. His case highlights a critical transition point in MASH care, from early intervention to maintenance and surveillance. When handled appropriately, these strategies can prevent recurrence and help patients sustain their remission over time.