after signing the consent form, you are assigned by the study system to receive either efimosfermin alfa or placebo without knowing which one you receive.

the assignment is done in a double‑blind manner, meaning neither you nor the study staff know the group during the trial.

a liver biopsy is performed to confirm the stage of mash (f2 or f3).

blood tests are taken to measure liver enzymes, cholesterol, glucose and other safety parameters.

imaging studies such as vibration‑controlled transient elastography (vcte) and controlled attenuation parameter (cap) are done to evaluate liver stiffness and fat content.

the first dose of the assigned product is given by a subcutaneous injection, which means the medicine is injected under the skin.

the product may be efimosfermin alfa (powder for solution for injection) or placebo (inactive substance).

the dose is defined by the study protocol and is administered according to the schedule set by the study staff.

treatment continues for a period of 52 weeks for the primary evaluation, with the possibility of extension up to 48 months for longer‑term assessment.

throughout the 52‑week treatment period you attend scheduled clinic visits to receive the next injection, undergo safety blood tests and report any adverse events.

the study team records any side effects, monitors laboratory values and ensures the medication is being taken as planned.

after completing 52 weeks of treatment, a second liver biopsy is performed to assess changes in fibrosis (scarring) and steatohepatitis.

additional blood tests and imaging studies are repeated to evaluate liver function and disease improvement.

if the study continues beyond 52 weeks, you may remain on the assigned medication for up to 48 months.

at month 48, further assessments are made to determine the time to any composite liver‑related clinical outcomes and to evaluate long‑term safety.

at the end of the treatment period (either week 52 or month 48), the final study visit includes a comprehensive safety evaluation, collection of blood samples for drug concentration measurement, and completion of questionnaires about quality of life.

after this visit the study medication is stopped and you receive information about any further follow‑up that may be required.