A Comparative Cross-Sectional Analysis of Liver Steatosis and Fibrosis Among MASLD Patients Treated with Different GLP-1 Receptor Agonist

The primary objective of study is to compare the effects of different glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on liver steatosis and fibrosis in patients with metabolic dysfunction–associated steatotic liver disease (MASLD). A comparative cross-sectional study was conducted on 357 MASLD patients treated with liraglutide (n=129), semaglutide (n=118), or dulaglutide (n=110) for at least six months. Liver steatosis and fibrosis were assessed using transient elastography, with controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) values analyzed. Multivariable linear regression was used to evaluate independent associations between GLP-1 RA type and hepatic outcomes, adjusting for demographic and metabolic covariates. Baseline demographics were similar across groups, though semaglutide users had lower BMI, ALT, triglycerides, and HbA1c. Semaglutide treatment was associated with significantly lower CAP (287.6 ± 41.3 dB/m) and LSM (8.1 ± 2.6 kPa) values compared to liraglutide and dulaglutide (p < 0.01). Multivariable analysis confirmed semaglutide independently reduced CAP (β = –22.8, p < 0.001) and LSM (β = –1.36, p = 0.001), while dulaglutide showed no significant effect. BMI, HbA1c, age, and diabetes duration were additional predictors of hepatic steatosis and fibrosis. The study concluded that Semaglutide demonstrates superior hepatoprotective effects compared with liraglutide and dulaglutide in MASLD patients, significantly reducing both liver fat content and fibrosis severity.