Novo Nordisk to Acquire Akero Therapeutics, Bolstering MASH Pipeline

Novo Nordisk to Acquire Akero Therapeutics for Up to $5.2 Billion

Novo Nordisk A/S (NVO), a global pharmaceutical leader, announced on October 9, 2025, its definitive agreement to acquire Akero Therapeutics, Inc. (AKRO), a clinical-stage biotechnology company, for a total consideration of up to $5.2 billion in cash. The acquisition aims to significantly expand Novo Nordisk's therapeutic portfolio within the rapidly evolving metabolic dysfunction-associated steatohepatitis (MASH) market.

Transaction Details and Premiums

Under the terms of the agreement, Akero shareholders will receive $54.00 per share in cash at closing. This upfront payment represents an equity value of approximately $4.7 billion. Additionally, shareholders will be eligible for a non-transferable Contingent Value Right (CVR) of $6.00 per share, payable upon full U.S. regulatory approval of Akero's lead product candidate, efruxifermin (EFX), for the treatment of compensated cirrhosis due to MASH by June 30, 2031. If achieved, the combined upfront and contingent payments represent an aggregate equity value of approximately $5.2 billion.

The upfront cash consideration offers a premium of 19% to Akero's 30-day Volume Weighted Average Price (VWAP) and a 42% premium to its closing price on May 19, 2025, prior to market speculation. The total potential consideration, including the CVR, represents a 32% premium to Akero's 30-day VWAP and a 57% premium over its May 19, 2025, closing price. The $54 per share cash component alone reflects a 16% premium to Akero's closing price of $46.49 on October 8, 2025.

Strategic Rationale and Market Positioning

This acquisition underscores Novo Nordisk's commitment to bolstering its leadership in metabolic diseases, particularly in the MASH treatment landscape. Akero's innovative efruxifermin (EFX) program, a fibroblast growth factor 21 (FGF21) analogue, is currently in Phase 3 development for moderate to advanced liver fibrosis (F2-F3) and compensated cirrhosis (F4) due to MASH, via its SYNCHRONY clinical trial program.

Novo Nordisk anticipates that EFX will complement its existing cardiometabolic portfolio, which includes Wegovy (semaglutide), a GLP-1 receptor agonist that recently received FDA approval for a MASH indication. Mike Doustdar, President and CEO of Novo Nordisk, stated:

"MASH destroys lives silently - and efruxifermin has the potential to change that by reversing liver damage. If approved, we believe it could become a cornerstone therapy, alone or together with Wegovy® (semaglutide), to tackle one of the fastest-growing metabolic diseases of our time."

Akero's CEO, Andrew Cheng, M.D., emphasized the strategic fit, noting:

"We are excited to enter into this agreement with Novo Nordisk, a global leader in metabolic disease, which we believe will maximize the value of EFX and accelerate its path to patients."

Financial Implications for Novo Nordisk

The transaction, primarily debt-financed, is not expected to alter Novo Nordisk's previously communicated operating profit outlook for 2025. However, it is projected to negatively impact the company's 2025 free cash flow outlook by approximately $4 billion, reflecting the expected enterprise value at closing. This adjustment is anticipated to result in an implied 2025 free cash flow outlook of 9-19 billion DKK.

Looking ahead to 2026, the acquisition is expected to increase research and development costs for Novo Nordisk, leading to an estimated negative impact of around 3 percentage points on the full-year operating profit growth.

Broader Market Context and Expert Commentary

The MASH treatment market has garnered significant attention from large pharmaceutical companies. The approval of Madrigal Pharmaceuticals' Rezdiffra in 2024 has further highlighted the commercial potential within this therapeutic area. Analysts view EFX as a promising asset; Jefferies analysts previously described Akero's data for efruxifermin as a "home run" that de-risked the asset. BMO Capital Markets characterized the current deal as a "clean pipeline fit" for Novo Nordisk, given its focus on metabolic disorders and the recent Wegovy approval for MASH.

The high prevalence of MASH among patients with type 2 diabetes and obesity—over 40% and 80% respectively—aligns directly with Novo Nordisk's core expertise and strategic long-term goals to address these interconnected comorbidities.

Outlook and Regulatory Path

The acquisition has been unanimously approved by Akero's Board of Directors and is subject to approval by Akero shareholders, along with customary closing conditions, including regulatory clearances. The transaction is anticipated to close around year-end 2025. Novo Nordisk will now oversee the continued development of efruxifermin through its Phase 3 SYNCHRONY program, with a target for U.S. regulatory approval by mid-2031 for the CVR payment. Investors will closely monitor the integration process and the progress of EFX through clinical trials, as well as the financial impact on Novo Nordisk's future earnings reports.