Global MASLD Consensus Links FibroScan and ELF Directly to Drug-Treatment Decisions:CGH | September 2026 | International Delphi Consensus
Introduction:
With pharmacotherapy now available for selected patients with MASH, clinicians need practical guidance on who should be treated and how response should be monitored. This 40-expert international consensus translates non-invasive tests (NITs) into treatment-oriented pathways.
Why was this consensus needed?
Liver biopsy is impractical for large-scale MASLD management.
FIB-4, VCTE and ELF are increasingly used for fibrosis risk stratification.
New therapies require practical non-invasive treatment thresholds.
Objective criteria for monitoring pharmacological response remain uncertain.
Key Takeaways:
Begin risk assessment with FIB-4, followed by VCTE or ELF when appropriate.
In noncirrhotic MASH, pharmacotherapy may be considered with liver stiffness 10–20 kPa or ELF 9.2–11.3.
Cirrhosis should be excluded before applying these treatment thresholds.
Eligible patients may be considered for resmetirom or semaglutide, according to phenotype and local approval.
Upfront resmetirom + semaglutide combination therapy is not recommended.
Cardiometabolic phenotype, contraindications and patient preference should influence drug selection.
At one year, ≥30% reduction in liver stiffness is proposed as evidence of treatment response.
Alternatively, an ELF reduction ≥0.5 points may indicate response.
These thresholds represent expert consensus, not prospectively validated treatment-response surrogates.
What’s New?
NITs move beyond fibrosis prediction toward direct treatment selection and response monitoring, linking FibroScan and ELF values to practical MASH pharmacotherapy decisions.
Bottom Line:
MASLD care is moving toward NIT-guided pharmacotherapy: FIB-4 identifies risk, VCTE/ELF helps select treatment, and serial NITs may monitor response—without routine liver biopsy.
