Steatotic liver disease (SLD) is a complex and dynamic condition, with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) being the primary focus of therapeutic development. The review highlights recent advancements in understanding the pathophysiology of SLD, including genetic, endocrine, and metabolic factors, and the need for non-invasive diagnostic tools. It discusses the expanding therapeutic pipeline for MASLD/MASH, detailing the mode of action and clinical trial progress of various pharmacotherapies. The review emphasizes the importance of targeting multiple pathways, such as metabolism, inflammation, and fibrosis, to improve cardiometabolic risk factors. The authors also highlight the need for interdisciplinary and coordinated approaches to manage SLD, recognizing it as a systemic disease affecting multiple organs. The review concludes by emphasizing the urgent need for novel therapeutic strategies and the potential of repurposing existing drugs to address the unmet clinical needs of SLD.Steatotic liver disease (SLD) is a complex and dynamic condition, with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) being the primary focus of therapeutic development. The review highlights recent advancements in understanding the pathophysiology of SLD, including genetic, endocrine, and metabolic factors, and the need for non-invasive diagnostic tools. It discusses the expanding therapeutic pipeline for MASLD/MASH, detailing the mode of action and clinical trial progress of various pharmacotherapies. The review emphasizes the importance of targeting multiple pathways, such as metabolism, inflammation, and fibrosis, to improve cardiometabolic risk factors. The authors also highlight the need for interdisciplinary and coordinated approaches to manage SLD, recognizing it as a systemic disease affecting multiple organs. The review concludes by emphasizing the urgent need for novel therapeutic strategies and the potential of repurposing existing drugs to address the unmet clinical needs of SLD.