A new drug is making waves in the fight against fatty liver disease. ALG-055009, a selective thyroid hormone receptor beta (THR-β) agonist, demonstrated significant, dose-dependent reductions in liver fat compared to placebo in a phase 2a clinical trial (HERALD). The 12-week randomized, double-blind study enrolled 102 non-cirrhotic adults with metabolic dysfunction-associated steatohepatitis (MASH) across multiple U.S. sites.

The drug performed especially well at higher doses, with the 0.7 mg and 0.9 mg groups showing placebo-adjusted liver fat reductions of 33.2% and 31.6%, respectively. Beyond liver fat, the drug also reduced LDL cholesterol, lipoprotein(a), and apolipoprotein B — a bonus for cardiovascular risk. Side effects were mostly mild to moderate, and no serious adverse events or deaths occurred in the treatment groups.

By the Numbers:

• 70% of patients on the 0.7 mg dose achieved ≥30% liver fat reduction vs. 9.5% on placebo
• 58.8% of patients on the 0.9 mg dose achieved ≥30% liver fat reduction
• 33.2% placebo-adjusted liver fat reduction at the 0.7 mg dose (p<0.0001)

Why it matters: MASH is a serious and growing liver condition with limited treatment options. A drug that reduces liver fat, improves atherogenic lipid profiles, and is well-tolerated could be a meaningful advance — though longer trials with liver biopsies are needed to confirm lasting benefit.