Rankings / Hormones & Endocrine
Resmetirom (Rezdiffra)
Hormones & Endocrine · Liver-selective THR-β agonist
Tier B
Bottom line
Read Off Label grades Resmetirom (Rezdiffra) as B (6.8/10) based on strong evidence, high benefit magnitude, and a med-risk safety profile.
Madrigal Pharmaceuticals.
Typical use: 80-100 mg PO once daily (weight-based) — Rx.
What this is
Madrigal Pharmaceuticals. First-ever approved drug for MASH/NASH — landmark approval after decades of failed candidates (e.g., obeticholic acid, elafibranor, selonsertib). Target population: MASH with F2/F3 fibrosis, ~6-7% of US adults. Prescribed by hepatology; expensive (~$47K/year list). Particularly relevant for biohacker readers given the strong overlap between metabolic syndrome and liver fat that Attia and others discuss frequently.
Mechanism
Liver-selective thyroid hormone receptor beta (THR-β) agonist; activates hepatic lipid catabolism, mitochondrial biogenesis, and autophagy without systemic hyperthyroid effects; first FDA-approved drug targeting metabolic dysfunction-associated steatohepatitis (MASH)
Dose & route
80-100 mg PO once daily (weight-based)
Citations
- https://doi.org/10.1056/NEJMoa2309000
- https://pubmed.ncbi.nlm.nih.gov/41895606/
- https://pubmed.ncbi.nlm.nih.gov/40868953/
- https://doi.org/10.1186/s12933-026-03140-0
- https://pubmed.ncbi.nlm.nih.gov/41545323/
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Common questions
- Does Resmetirom (Rezdiffra) work?
- Read Off Label rates the evidence for Resmetirom (Rezdiffra) as Strong and the benefit magnitude as high, producing an overall grade of B (6.8/10). Madrigal Pharmaceuticals.
- Is Resmetirom (Rezdiffra) safe?
- Resmetirom (Rezdiffra) has a med risk profile in published human data. Legal status: Rx (FDA-approved March 2024 for noncirrhotic MASH with moderate-advanced fibrosis F2/F3). This is not medical advice — see the disclaimer.
- What is the typical dose for Resmetirom (Rezdiffra)?
- 80-100 mg PO once daily (weight-based)
- How does Resmetirom (Rezdiffra) work?
- Liver-selective thyroid hormone receptor beta (THR-β) agonist; activates hepatic lipid catabolism, mitochondrial biogenesis, and autophagy without systemic hyperthyroid effects; first FDA-approved drug targeting metabolic dysfunction-associated steatohepatitis (MASH)
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.