Semaglutide’s ESSENCE phase 3 trial (72-week interim, AASLD 2024) showed 62.9% MASH resolution without fibrosis worsening (vs. 34.1% placebo; EDP 28.9%, P < 0.0001) and 37.0% fibrosis improvement without MASH progression (vs. 22.5%; EDP 14.5%, P < 0.0001), via GLP-1 metabolic/inflammatory effects and 10.5% weight loss, with 30%–40% liver enzyme/fibrosis marker reductions; GI AEs increased (nausea 36%, diarrhea 27%), and modest fibrosis gains highlight combo therapy potential (127). This evidence concerns the gene GLP1R and fibrosis.