Survodutide week 52 extension: ALT fell 71→38 but CAP stalled

CAP can lag. My ALT normalized around week 40, CAP took another 4 months to budge.

Agree that CAP lags, but 312 isn’t tiny. Did your MRI-PDFF change at all?

The phase 2 MASH biopsy numbers are what got me interested: 83% vs 18% for MASH improvement. But that placebo response tells me histology isn't clean either. Enzymes are noisy, CAP is noisy, PDFF is nicer but not an outcome. Your ALT drop with flat CAP could still be real drug effect or just trial noise. I'm waiting for phase 3 fibrosis data before I trust any of it. If phase 3 shows fibrosis benefit, the imaging discordance won't matter much; if not, we're just measuring weight loss proxies. At least that’s how I read the phase 2/3 gap.

My CAP dropped first, ALT trailed. Bodies are annoyingly nonsynchronous.

What does your trial coordinator say about unblinding? Ours wouldn’t until database lock.

I’d separate drug effect from trial noise. In phase 2, the higher-dose arm looked strong on histology, but GI dropout was real. If phase 3 confirms fibrosis benefit, CAP discordance won’t matter. If it doesn’t, we’re back to weight-loss proxy. Are you tracking ELF or Pro-C3? Those feel more stable than CAP for me. I’ve been in a different metabolic trial and my Pro-C3 fell before ALT, which made me rethink which markers I follow. Still, none of these are validated as surrogates in every cohort, so I get why the biopsy endpoint remains the anchor.

Placebo biopsy response kills my phase 2 hype.

I’m at week 61 and mine went the other way—CAP dropped from 328 to 296 by week 20, while ALT sat in the 60s until around week 34 before finally hitting 31, so I get how backwards this feels. The weird part was my weight only moved 6.8% in that first stretch, and the CAP change lined up almost exactly with my waist going down 1.5 inches from adding a 30-minute after-dinner walk and cutting weekday alcohol, not from any big scale drop. I’ve started tracking waist at the same time every Sunday and sleep hours, because my FibroScan numbers looked cleaner after I got consistent sleep and my enzymes were the last thing to cooperate. Did your scans use the same probe/site each time? I had a 20-point CAP swing just from a different tech and a fuller stomach.

I feel you on the discordance stress. I’m at week 38, and my enzymes normalized around week 20 while my CAP didn’t budge until maybe week 34. What actually kept me sane was ignoring the liver numbers for a stretch and tracking my belt instead: down 4 notches since January, waist from 44 to 41, but I had a solid six-week plateau where the scale and the scan both stared back at me. The turn came when I stopped chasing the CAP number and just added a 20-minute walk after dinner most nights. Not saying that’s why, but the next scan finally moved. Weirdly, my ALT bumping back up a tiny bit last month coincided with a terrible sleep stretch and more weekend takeout, so I’m now watching stress and sodium as much as the liver panel. Are you noticing any of your own non-scale signals trending better even while the CAP sits still?

My CAP stalled for months then finally budged—it lags my labs too. Hang in there 🤞

Totally get the head mess—mine stalled then finally budged; labs moved first 💛

Cafe owner here too. My CAP sat at 318 for two scans while labs improved, then dropped 26 points once I started weighing the “little tastes” — pastry cream, oil drizzle, broken cookies. That was easily 300–400 extra kcal/day, and my wist moved before my weight did. Do you have baseline waist or fasting glucose/insulin to compare? Curious whether your 9.4% loss was more visceral early on versus now.