The management of metabolic dysfunction-associated steatohepatitis (MASH) is entering a new era. Recent approval of two anti-MASH therapies has fundamentally changed the clinical landscape after decades during which only lifestyle intervention was available.

However, this achievement creates novel clinical challenges: who should be treated, when treatment should begin, how to monitor therapeutic response, and how to integrate therapies effectively into healthcare systems. The World Health Organization's recent decision to recognise Steatotic Liver Disease (SLD) as a component of the global non-communicable disease agenda represents a historic opportunity to position liver health within integrated metabolic strategies.

Europe faces a major implementation gap despite these scientific advances. Innovative therapies alone will not improve patient outcomes unless healthcare systems can identify eligible patients, provide equitable access, and ensure sustainable reimbursement. Fragmented patient pathways, heterogeneous screening strategies, limited multidisciplinary awareness, uncertainty regarding non-invasive testing, and misalignment between regulatory approval and national payer expectations all represent substantial barriers.

MASH is closely linked with obesity, type 2 diabetes, cardiovascular disease and chronic kidney disease. Successful implementation therefore requires multidisciplinary collaboration beyond hepatology, involving diabetologists, obesity specialists, primary care physicians, cardiologists, nephrologists, public health experts and patient organisations.

To address these challenges, EASL proposes the EASL MASH Innovation and Implementation Roadmap, a long-term, multi-stakeholder initiative designed to bridge the gap between scientific innovation and real-world patient access across Europe. This platform will bring together all stakeholders in the MASH ecosystem through structured dialogue and consensus building to identify evidence gaps, define implementation priorities, and develop practical recommendations facilitating equitable and sustainable access to MASH care throughout Europe.