Incretin-based therapies in hepatology practice

Table 2 Suggested baseline and follow-up assessment

Clinical scenario	Assessment
Baseline	Alcohol history; metabolic risk factors; body weight, body mass index and/or waist circumference; ALT, AST, platelet count, HbA1c, lipid profile, renal function, and FIB-4
Low FIB-4 and no clinical concerns	Continue metabolic treatment; repeat liver risk assessment periodically according to metabolic risk and local pathway
Indeterminate or high FIB-4	Perform second-line non-invasive testing: Transient elastography, ELF testing, or hepatology referral
During ongoing therapy	Body weight and body mass index; tolerability and gastrointestinal adverse effects; HbA1c and fasting lipids; ALT, AST, platelet count, FIB-4 trajectory; renal function and hydration risk
After meaningful weight loss	Reassess liver enzymes and fibrosis risk markers; avoid concluding that weight loss alone indicates fibrosis regression
Older adult or frailty risk	Assess nutritional intake, muscle strength or function when feasible, fall risk, medication burden, and need for resistance exercise and protein optimization
Advanced fibrosis or cirrhosis	HCC surveillance per guideline; portal hypertension assessment; nutrition and frailty monitoring; decompensation monitoring; transplant consideration when appropriate

FIB-4: Fibrosis-4 index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HbA1c: Glycated hemoglobin; ELF: Enhanced Liver Fibrosis test; HCC: Hepatocellular carcinoma.