MTE #22: Navigating Metabolic Dysfunction–Associated Steatotic Liver Disease in Autoimmune Liver Disease—Diagnostic Dilemmas (Ticketed)

Metabolic dysfunction–associated steatotic liver disease (MASLD) is now so prevalent that coexistence with autoimmune liver diseases—including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC)—has become a frequent real-world scenario. This comorbid overlap creates diagnostic uncertainty and introduces management tradeoffs. Experts synthesize what is known about the prevalence and clinical impact of MASLD overlap in autoimmune liver diseases, drawing from the most up-to-date literature and emerging registry data. Presenters review signals that MASLD may worsen prognosis and treatment response in cholestatic and autoimmune hepatitis, which are increasingly recognized and under active study. Speakers also focus on practical diagnostic and management approaches: phenotype parsing (metabolic versus immune activity); use and limitations of noninvasive tests and histology; and an integrated treatment strategy that addresses both autoimmune disease control and metabolic drivers of progression. Faculty conclude by addressing how new metabolic dysfunction–associated steatohepatitis (MASH)–directed agents intersect with autoimmune liver disease care—including where therapies such as resmetirom fit conceptually and operationally, and what safety/monitoring considerations are especially relevant when concomitant or uncontrolled autoimmune liver disease is present. Attendees gain a pragmatic framework for evaluating overlap, prioritizing interventions, and anticipating the next wave of evidence in this rapidly evolving space.