Liver disease is a growing global health concern, yet many of its most serious forms remain under-recognized and underdiagnosed. Metabolic dysfunction-associated steatohepatitis (MASH) stands out as a particularly urgent challenge. MASH disease is a progressive liver condition closely tied to metabolic dysfunction. It has been estimated that MASH cases in the United States will increase by 82.6% to 19.53 million by 2039.1 At the same time, it is rapidly becoming a leading cause of liver-related morbidity and mortality, and one of the most common drivers of liver transplantation.2
What was once a silent and overlooked condition is now at an inflection point. Advances in diagnostics, a shift in disease nomenclature and the emergence of the approved therapies are transforming how MASH is identified and treated.
This blog explores how our understanding of MASH is evolving, and what comes next as the pipeline accelerates.
Previously known as nonalcoholic steatohepatitis (NASH), MASH is part of the broader spectrum now called metabolic dysfunction-associated steatotic liver disease (MASLD)
In 2023, global liver experts adopted this updated nomenclature to better reflect disease biology and reduce stigma.3,4
This shift aims to:
The change is more than semantic. It aligns liver disease with cardiometabolic health, reinforcing the need for integrated care across specialties.
MASH is now one of the most pressing challenges in liver health. It is the leading cause of chronic liver disease, with projections suggesting it will soon become the primary driver of liver cancer and transplantations in the United States.2,5 Despite this trajectory, the majority of patients remain undiagnosed.6,7
Real-world data from Symphony Health, a HealthVerity company, provides insight into the demographic profile of MASH patients (Figure 1). Analyzing patients in the U.S. with at least one medical claim for MASH between January 2021 and December 2025, the data show:
Figure 1: Source: Symphony Health, a HealthVerity company: Open claims data from Integrated Dataverse (IDV®) - Patients with at least 1 MASH diagnosis claim from January 2021-December 2025. For fibrosis or cirrhosis, they also need at least 1 diagnosis claim indicating fibrosis or cirrhosis. For no fibrosis or cirrhosis, they did not have any diagnosis claims indicating fibrosis or cirrhosis within the timeframe.
Although real world data leans towards individuals utilizing healthcare services, it can provide valuable insights into uncovering disparities and identifying at-risk populations.
One of the greatest challenges with MASH is its asymptomatic nature in early stages. Patients often show no signs until advanced fibrosis or cirrhosis has developed.
Traditional diagnostic approaches have limitations:
These barriers, combined with low awareness among both patients and clinicians, has led to widespread underdiagnosis. However, the diagnostic landscape is evolving, with non-invasive diagnostics, such as composite scores with laboratory tests (e.g., FibroScan-AST [FAST] score, MRI-AST [MAST] score), becoming more accessible.
These advances are enabling earlier identification and risk stratification, which is critical as treatment options expand.
After decades without approved therapies, the MASH treatment landscape has changed with the US Food and Administration (FDA) approval of 2 treatments:
These approvals mark a new era in MASH management. While lifestyle changes remain essential, clinicians now have pharmacological tools to slow disease progression.
The treatment pipeline is also rapidly expanding, with therapies targeting multiple disease drivers, including lipid metabolism, inflammation and fibrosis.10 Given the complexity of the disease, emerging strategies are focusing on combination approaches and next-generation metabolic agents, along with efforts to better stratify patients for more targeted treatments.
MASH rarely exists in isolation and is often deeply intertwined with other chronic conditions such as obesity and type 2 diabetes.11,12 Most patients live with multiple cardiometabolic comorbidities which accelerate liver disease progression and complicate treatment.
Among those with fibrosis or cirrhosis, the prevalence of comorbidities is even higher, highlighting the strong link between advanced liver disease and systemic metabolic dysfunction (Figure 2).
Effective management requires more than just targeting MASH. A holistic, multidisciplinary approach that addresses both liver health and underlying metabolic dysfunction is essential for optimal care.
Figure 2: Comorbidities associated with MASH patients from January 2021-December 2025
MASH is no longer just a silent epidemic. It is an evolving therapeutic area at a pivotal moment. Momentum is benign driven by:
Real-world data plays a key role in bridging research and practice. It can support clinical trial design through patient identification, site selection, and external control arms, as well as inform commercialization by mapping patient journeys, treatment patterns, and payer dynamics. Real world data can also be used to provide critical insights into how MASH is diagnosed, treated and managed outside clinical trials. These insights help identify undiagnosed patients, close gaps in care and measure the real world impact of new therapies.
Additionally, real world data enables a deeper understanding of market access and payer decision-making as MASH treatments carry high cost and face utilization management. By analyzing payer dynamics, stakeholders can better anticipate access barriers, demonstrate value and design evidence strategies that support broader and equitable adoption.
The challenge is clear. Addressing MASH requires increasing awareness, reducing stigma, expanding screening and ensuring equitable access to innovative treatments. By combining clinical progress with real-world data, payer insights and a comprehensive patient journey, we can bring MASH out of the shadows and help transform the future of liver health.
The HealthVerity acquisition of Symphony Health represents a shift away from fragmented, legacy data models toward a unified, connected ecosystem. By combining clinical depth with commercial scale, the solution delivers integrated, analytics-ready data, reveals patients and providers previously hidden, and accelerates time from insight to action. The result is less time stitching data and more time driving decisions.
Learn more about what this means for you. Connect with us to discover how the largest unified, connected ecosystem can support your clinical research.