The management of Metabolic Dysfunction-Associated Steatohepatitis (MASH) is entering a new era. Following the approval of MASH targeted therapies such as resmetirom and semaglutide, clinicians are increasingly faced with two critical questions: which patients are eligible for treatment, and how should treatment response be monitored over time?
The newly released 2026 EASL-EASD-EASO Guidance provides important answers, placing non-invasive liver assessment at the center of therapeutic decision-making. Notably, Liver Stiffness Measurement (LSM) by VCTE® using FibroScan® is now integrated into both treatment eligibility and monitoring pathways for patients with MASH.
This represents a significant step forward for evidence-based, patient-friendly liver care, reducing reliance on invasive procedures while supporting treatment decisions across the patient journey.
The evolving role of FibroScan® in MASH management
The guidance builds upon the fibrosis risk stratification algorithm introduced in the 2024 MASLD Clinical Practice Guidelines, maintaining the established sequential pathway:
FIB-4 → FibroScan® (LSM by VCTE®)
While this diagnostic framework remains unchanged, the clinical utility of FibroScan® has expanded considerably.
Historically used to identify and stage liver fibrosis, FibroScan® now plays a broader role in the management of patients with non-cirrhotic MASH by helping clinicians:
– Assess fibrosis severity non-invasively
– Identify patients who may benefit from MASH-targeted therapies
– Exclude patients with suspected cirrhosis requiring alternative care pathways
– Monitor treatment effectiveness over time
The integration of LSM based criteria into treatment recommendations reflects the growing recognition of non-invasive tests as essential tools in modern hepatology practice.
Which patients are eligible for MASH targeted therapies?
According to the 2026 EASL-EASD-EASO Guidance, adults with suspected MASH and evidence of fibrosis should undergo structured non-invasive assessment before treatment decisions are made.
Patients may be considered eligible for currently approved MASH-targeted pharmacological therapies if they meet one of the following criteria:
– Biopsy-confirmed fibrosis stage F2-F3
– Liver Stiffness Measurement by FibroScan® between 10 and 20 kPa, confirmed by repeat assessment or another validated non-invasive test
– Magnetic Resonance Elastography (MRE) between 3.1 and 5.0 kPa
– Enhanced Liver Fibrosis (ELF™) score between 9.8 and 11.3
These recommendations provide clinicians with practical, non-invasive options for identifying patients who may benefit from treatment without systematically requiring liver biopsy.
Importantly, patients presenting with LSM values above 20 kPa should undergo further assessment for possible cirrhosis. Because currently approved therapies are indicated for patients with non-cirrhotic MASH and significant fibrosis, these individuals may require alternative management strategies.
Why confirmation of elevated liver stiffness matters
The guidance highlights the importance of confirming elevated liver stiffness measurements before initiating treatment.
When eligibility is based on FibroScan® results, a repeat examination or confirmation using another validated non-invasive test is recommended. This approach aims to strengthen diagnostic confidence, improve patient selection, and ensure that treatment decisions are based on robust and reproducible clinical evidence.
By encouraging confirmation through non invasive methods, the guidance further supports the transition away from routine liver biopsy whenever appropriate.
FibroScan® emerges as a valuable tool for treatment monitoring
One of the most impactful additions in the 2026 guidance is the recognition of FibroScan® as a potential tool for monitoring therapeutic response.
The document highlights that a confirmed reduction of at least 30% in liver stiffness may be associated with a lower risk of major liver-related outcomes, including:
– Hepatic decompensation
– Hepatocellular carcinoma (HCC)
– Progression of liver disease
These findings strengthen the role of FibroScan® beyond diagnosis and fibrosis staging, positioning LSM as a clinically meaningful parameter that can help track disease evolution and treatment effectiveness over time.
For healthcare professionals managing patients with MASLD and MASH, access to a repeatable, non-invasive monitoring tool may facilitate longitudinal follow-up while reducing patient burden.
What do the new recommendations mean for clinical practice?
The message delivered by the 2026 EASL-EASD-EASO Guidance is clear: non-invasive tests are becoming increasingly central to the management of metabolic liver disease.
Today, FibroScan® contributes throughout the continuum of care by supporting:
– Early identification of at-risk patients : FibroScan® helps identify patients with significant fibrosis who may require additional evaluation and closer management.
– Treatment eligibility assessment : LSM thresholds are now incorporated into recommendations guiding access to MASH-targeted therapies.
– Identification of potential cirrhosis: Patients with high liver stiffness values can be rapidly identified and directed toward appropriate specialist care.
– Long-term treatment monitoring: Serial FibroScan® assessments may provide valuable insights into treatment response and disease progression.
Advancing non-invasive care in MASLD and MASH
As therapeutic options continue to expand, the need for scalable, accessible and evidence-based patient pathways has never been greater.
The 2026 EASL-EASD-EASO Guidance marks an important milestone by formally integrating Liver Stiffness Measurement by VCTE® with FibroScan® into treatment eligibility and monitoring strategies for MASH-targeted therapies.
More than a fibrosis assessment tool, FibroScan® is increasingly becoming an integral component of clinical decision-making, supporting physicians in diagnosis, risk stratification, treatment selection, and longitudinal patient management.
As healthcare systems prepare for a growing population of patients with MASLD and MASH, non-invasive technologies such as FibroScan® are poised to play a key role in delivering efficient, patient-centered liver care.
Reference
European Association for the Study of the Liver (EASL). Electronic address: [email protected] et al. “EASL-EASD-EASO Guidance for the Use of Resmetirom and Semaglutide as MASH-Targeted Therapy.” Journal of hepatology, S0168-8278(26)02877-1. 1 Dec. 2026
