Uncovering the Current Landscape of MASH Treatment in Germany: Insights From a Delphi Panel

OBJECTIVES: A Delphi panel aimed to evaluate treatment modalities and characteristics of patients with metabolic dysfunction-associated steatohepatitis (MASH), previously termed nonalcoholic steatohepatitis (NASH), in Germany. The panel focused on quantifying the benefits of emerging therapies and assessing best practices in the diagnosis and management of MASH.

METHODS: A three-round survey using the Delphi method was completed by 12 experts, including hospital-based and outpatient physicians located across Germany. Participants independently answered an online questionnaire unaware of the identities and responses of other participants. The survey included exploratory and consensus questions. Consensus was defined as the achievement of a 75% level of agreement among the panelists. The survey topics were related to MASH and included participant information, MASH definitions, epidemiology, diagnosis, current treatments, comorbidity management, pharmaceutical therapy, and patient education.

RESULTS: The presence of hepatic fibrosis was identified as the most critical prognostic factor for MASH. Experts estimated that approximately 75% of MASH patients are undiagnosed. Most patients are referred to the participating experts by general practitioners due to abnormal liver function tests. Current treatment strategies heavily rely on lifestyle changes and managing comorbidities like diabetes and cardiovascular diseases; pharmaceutical options are limited due to a lack of approved medications. Non-invasive methods such as transient liver elastography (e.g. to measure liver scarring or fibrosis), were preferred over liver biopsy for diagnosis and monitoring MASH.

CONCLUSIONS: The study highlights significant challenges in managing MASH in Germany, including lack of approved pharmaceutical treatments and insufficient patient education. Emphasizing lifestyle modifications and comorbidity management remains essential until more targeted therapies become available.