Incretin-modulating therapies, including Wegovy and Zepbound, are transforming obesity treatment, impacting vital organs and offering a holistic approach to metabolic dysfunction-associated steatohepatitis (MASH). Despite early challenges, therapies like Novo Nordisk's semaglutide show promise in MASH Phase III trials. Dual agonism approaches, such as Zepbound and Boehringer Ingelheim's survodutide, demonstrate significant fibrosis improvement in Phase IIb results. Distinctions in receptor agonism effectiveness for MASH treatment are noted, with GLP-1/glucagon receptor agonists potentially more effective. Multiple companies, including Eli Lilly and Altimmune, are advancing their MASH therapies, with Phase III trials planned for 2024. The competitive MASH treatment pipeline emphasizes diverse mechanisms of action, with incretin-modulating treatments expected to be pivotal in future MASH management.