Jonathan Stine, MD, MSc, is an associate professor of medicine and public health science and director of the Fatty Liver Program at Penn State University.

Jonathan Stine, MD, MSc

Developing a Multidisciplinary Care Model for MASLD, with Jonathan Stine, MD, MSc

New research is calling attention to the potential utility of a novel multidisciplinary care model for adult patients with 

metabolic dysfunction-associated steatotic liver disease (MASLD)

Historically, MASLD treatment relied solely on lifestyle changes, including diet, exercise, and weight loss. The treatment landscape underwent a hisotrical development in March 2024, when the US Food and Drug Administration (FDA) granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra) for the treatment of noncirrhotic 

metabolic dysfunction-associated steatohepatitis (MASH)

 with moderate to advanced fibrosis, making it the first and only FDA-approved pharmacologic treatment option for the progressive liver disease.

Despite the availability of a pharmacologic treatment option for patients, lifestyle interventions continue to play a pivotal role in their care. Because MASLD is a multisystem metabolic disorder affecting much more than just the liver, its treatment is complex and requires attention from multiple specialties.

Although multidisciplinary MASLD care has been endorsed by leading hepatology societies, it has not been widely implemented in clinical practice, largely due to a lack of standardization.

“We saw several important areas to improve upon models that already existed, and our goal was [to create] this one stop shop for all patients,” Jonathan Stine, MD, MSc, an associate professor of medicine and public health science and director of the Fatty Liver Program at Penn State University, explained to 

Some of the key elements to this improved care model include the colocation of specialists in the same clinic to allow patients to move through a structured sequence of visits with multiple providers all in the same clinical space and the inclusion of a standardized lifestyle assessment and intervention, including counseling on diet, exercise, sleep hygiene, alcohol, and smoking cessation.

Additionally, the model integrates pharmacologic management for patients who may benefit from resmetirom, GLP-1 RAs, or clinical trials and provides individualized, coordinated management for each patient with their entire care team.

“This model is the most comprehensive one out there that I've seen,” Stine said. “many existing programs lack key specialists such as exercise physiologists or obesity medicine experts. By providing these key health care providers, we've been able to enhance the effectiveness of lifestyle intervention when paired with drug therapy, and then ultimately improve some of the medical outcomes shown in the primary paper.”

Between October 2023 and August 2024, 78 consecutive adults were enrolled in the multidisciplinary care model, 26 of whom had data available at 6 months. In these patients, several improvements in liver health and metabolic health were observed. Specifically, investigators noted 39% achieved a clinically meaningful reduction in ALT and 79% achieved A1c <7%.

Additionally, 72% of patients achieved LDL <100 mg/dL, including 69% of patients with diabetes. Results also showed 50% achieved SBP ≤130 mm Hg; 35% achieved guideline-based amounts of weekly physical activity; and 26% achieved body weight loss of ≥5%.

“If we can demonstrate that multidisciplinary care improves outcomes while also being cost effective, I really believe this will become the new standard for MASLD management,” Stine said.

Editors’ note: Stine has relevant disclosures with Astra Zeneca, Galectin, Kowa, Noom Inc., Novo Nordisk, and Zydus Therapeutics.

Brooks A. Multidisciplinary Care Model Improves Liver, Metabolic Outcomes in MASH. February 20, 2025. Accessed February 27, 2025. 

https://www.hcplive.com/view/multidisciplinary-care-model-improves-liver-metabolic-outcomes-mash

Videos

Stine explains key components of a new multidisciplinary MASLD care model and how it improves upon preexisting models.

The Importance of Multidisciplinary MASLD Care, with Jonathan Stine, MD, MSc

A comprehensive care team approach may have significant implications for improving 

 care, with new research shedding light on the potential utility of a multidisciplinary care model for adult patients with MASLD and significant liver fibrosis.

In March 2024, the US Food and Drug Administration (FDA) granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra) for the treatment of noncirrhotic 

 with moderate to advanced fibrosis, making it the first and only FDA-approved pharmacologic treatment option for the progressive liver disease. However, unmet needs still persist.

“Lifestyle intervention still remains the cornerstone of management, but resmetirom has provided an additional tool for our patients, many of whom are struggling to achieve sufficient weight loss or metabolic improvement through diet and exercise alone,” Jonathan Stine, MD, MSc, an associate professor of medicine and public health science and director of the Fatty Liver Program at Penn State University, told 

He noted conversations with patients have evolved over the past year since resmetirom was introduced as a pharmacologic treatment option, citing questions about the need to focus on lifestyle changes if taking a medication.

“As a lifestyle researcher, my answer is absolutely a resounding yes,” he said. “The data still support that diet and exercise are essential for improving liver and metabolic health, and that no single drug is really the magic bullet."

Stine went on to call attention to a growing interest in multidisciplinary approaches to MASLD care due to the fact that it is a multisystem metabolic disorder affecting much more than just the liver. He noted many patients with MASLD also have conditions like obesity, diabetes, high blood pressure, and high cholesterol, all of which can contribute to disease progression but have historically been treated “in isolation” through separate, independent specialists.

“This has been largely ineffective, and that's where the push for multidisciplinary care really comes in,” Stine explained. “The idea is to bring all the necessary expertise, including hepatologists, endocrinologists, obesity medicine specialists, together under one roof to ensure we're addressing the disease comprehensively, rather than just treating it in silos.”

“In my opinion multidisciplinary care is here,” Stine said. “But now, the challenge is how do we create a standardized model that we can implement more widely?”

Brooks A. Multidisciplinary Care Model Improves Liver, Metabolic Outcomes in MASH. February 20, 2025. Accessed February 26, 2025. 

Stine explains the continued need for diet and exercise in MASH and the importance of a multidisciplinary approach to treating these patients.

Jonathan Stine, MD, MSc

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