Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease posing a major global health concern, closely related to the rising prevalence of obesity. Liver fibrosis is the primary determinant of adverse outcomes in MASH. The increasing worldwide prevalence, economic impact, and adverse outcomes of MASH-associated fibrosis have spurred extensive research to elucidate its pathogenesis and to address its treatment. However, the intricate mechanism driving the transition from metabolic dysfunction to clinically significant fibrosis is not fully understood. Moreover, effective therapies, particularly direct antifibrotic agents, are still lacking, despite the recent approval of resmetirom and semaglutide for MASH-associated fibrosis. Here, we review current insights into the mechanism of MASH-associated fibrosis and provide a comprehensive overview of emerging therapeutic strategies.