Resmetirom and semaglutide therapy for patients with MAFLD in the MENA region: Expert panel recommendations

Introduction: Metabolic dysfunction–associated fatty liver disease (MAFLD) affects 25–30% of the global population, with the Middle East and North Africa (MENA) region showing some of the highest prevalence rates, reaching up to 40%. MAFLD is a common cause of cirrhosis and hepatocellular carcinoma and is a leading indication for liver transplantation in this region. Hitherto, there have been no specific pharmacotherapies for MAFLD. However, the recent conditional approval of resme tirom and semaglutide by the FDA for the treatment of non-cirrhotic moderate-to-advanced (fibrosis stages 2 or 3) metabolic-associated steatohepatitis (MASH) offers a much-needed therapeutic option for this largely underserved condition. Areas covered: An expert panel from the MENA region conducted a comprehensive literature search via PubMed and Google Scholar, focusing on clinical trials and international guidelines for resmetirom and semaglutide. This review identifies the target treatment population, proposes criteria for cessation of therapy, outlines monitoring protocols, and addresses regional knowledge gaps. Expert opinion: The approval of the first two drugs for MASH is a milestone. Access to and affordability of these therapies will be the crucial determinants of their actual adoption. Future efforts should consider individualized treatment pathways stratified by cost, regulatory status, and healthcare infra structure, while generating further regional evidence.