Durmus ME, Koker G, Ocal S. Incretin-based therapies in hepatology practice. World J Hepatol 2026; 18(10): 125275 [DOI: 10.4254/wjh.125275]
Corresponding Author of This Article
Gokhan Koker, MD, Associate Professor, Department of Internal Medicine, University of Health Sciences, Antalya Training and Research Hospital, Varlik St. Antalya Training and Research Hospital, Antalya 07100, Türkiye. gokhan.koker@sbu.edu.tr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2026; 18(10): 125275 Published online Oct 27, 2026. doi: 10.4254/wjh.125275
Incretin-based therapies in hepatology practice
Merve Eren Durmus, Gokhan Koker, Serkan Ocal
Merve Eren Durmus, Serkan Ocal, Department of Gastroenterology, University of Health Sciences, Antalya Training and Research Hospital, Antalya 07100, Türkiye
Gokhan Koker, Department of Internal Medicine, University of Health Sciences, Antalya Training and Research Hospital, Antalya 07100, Türkiye
Author contributions: Durmus ME and Koker G conceptualized and designed the review, performed the literature review and drafted the manuscript; Koker G and Ocal S critically revised the manuscript for important intellectual content; all authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: No artificial intelligence (AI) tools were used in the research, analysis, interpretation, writing, or editing of this manuscript. The authors take full responsibility for the integrity, accuracy, originality, and scientific validity of the manuscript and all submitted materials.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Gokhan Koker, MD, Associate Professor, Department of Internal Medicine, University of Health Sciences, Antalya Training and Research Hospital, Varlik St. Antalya Training and Research Hospital, Antalya 07100, Türkiye. gokhan.koker@sbu.edu.tr
Received: July 7, 2026 Revised: July 31, 2026 Accepted: August 31, 2026 Published online: October 27, 2026 Processing time: 111 Days and 5.6 Hours
Abstract
Glucagon-like peptide-1 receptor agonists and dual incretin therapies are now encountered routinely in hepatology, well beyond their initial use as glucose-lowering agents. Their relevance to steatotic liver disease is largely indirect. By reducing obesity, insulin resistance, adipose tissue dysfunction, systemic inflammation and cardiometabolic risk, they address several processes underpinning metabolic dysfunction-associated steatotic liver disease and, in some patients, metabolic dysfunction-associated steatohepatitis. Biopsy-based trials have shown improvement in steatohepatitis activity, while recent studies of semaglutide, tirzepatide and glucagon-like peptide-1/glucagon co-agonists have also reported favorable fibrosis-related findings. Real-world cohorts suggest lower rates of progression to cirrhosis, decompensation and hepatocellular carcinoma, although the results are inconsistent and remain open to residual confounding. These observations should be interpreted carefully in clinical practice. Loss of body weight or decreased aminotransferase levels should not be treated as proof of hepatic benefit, nor should incretin therapy be regarded as liver-directed treatment on those grounds alone. A more appropriate approach is to place these agents within a fibrosis-based pathway that includes baseline risk assessment, sequential non-invasive testing, attention to nutritional status and frailty, and continued cirrhosis and hepatocellular carcinoma surveillance in patients with established advanced liver disease. This review examines the available evidence and outlines a practical algorithm for hepatology care.
Core Tip: Incretin-based therapies are important in hepatology because they act on the metabolic drivers of steatotic liver disease. Their hepatic benefit should be judged by fibrosis-oriented monitoring rather than by weight loss. Histological and real-world data are encouraging, but whether these drugs prevent decompensation, hepatocellular carcinoma, transplantation or liver-related death is unclear. They are best regarded as partners to liver-directed therapy, not as replacements for standard cirrhosis care and surveillance.
