We fully agree with Ryu et al.’s work, as well as their correspondence regarding our opinions on the potential interest in evaluating hepatic fibrosis dynamics and long-term liver-related outcomes among individuals who attain sustained virologic response (SVR) following direct-acting antivirals (DAAs) for hepatitis C virus (HCV) [1-3].

Apart from the short-term improvement of the fibrosis index based on four parameters (FIB-4) and liver stiffness measurements (LSMs) using vibration-controlled transient elastography (VCTE), which has been well demonstrated by the authors, it would be even more insightful to assess the long-term dynamics of serum glycemic and total cholesterol levels in relation to the time-dependent evolution of FIB-4 or LSMs, either through VCTE or magnetic resonance elastography (MRE). Preferably, this should be done using repeated measurements. This approach could help identify individuals at risk for unfavorable liver-related outcomes, such as hepatic decompensation or hepatocellular carcinoma (HCC). To better understand the complex interactions between metabolic dysfunction and hepatic fibrosis evolution at both the population and individual levels, applying generalized estimating equations (GEE) or generalized linear mixed models (GLMMs) would be beneficial [4-6].

In line with the authors’ comments on future research aiming to estimate the risk of insulin sensitizers or lipid-lowering agents for fibrosis regression in individuals with metabolic dysfunction following HCV cure, the role of selective thyroid hormone receptor-beta (THR-β) agonists, such as resmetirom, in mitigating or reversing hepatic fibrosis progression deserves further investigation in this population [7].