Current evidence of real-world experience with resmetirom in clinical practice in the United States: a targeted literature review

Metabolic dysfunction–associated steatotic liver disease is the most common chronic liver disease globally and progresses to metabolic dysfunction–associated steatohepatitis (MASH) in up to 30% of individuals. In 2024, the thyroid hormone receptor β agonist resmetirom became the first pharmacotherapy to receive accelerated conditional US approval for adults with MASH and moderate to advanced fibrosis (consistent with F2 to F3), for use in conjunction with diet modification and regular exercise. A targeted literature search was conducted in PubMed, Embase, and Europe PMC, to identify reports published in English through 31 March 2026. Congress repositories were manually searched through 30 June 2026. Early real world data on resmetirom in the US are encouraging, with signals supporting the efficacy findings reported in the phase 3 MAESTRO-NASH trial. Clinical practice is shifting toward noninvasive testing for patient identification and monitoring. The MASH landscape is transitioning from being limited to lifestyle modifications to the availability of pharmacotherapy; real world use of resmetirom suggests a shift toward use of a liver-directed therapy to manage MASH.