Madrigal Pharma reports $364.3M in Rezdiffra sales, up 71%

Key Takeaways:

Rezdiffra net sales hit $364.3 million in Q2 2026, up 71% year over year
Active patients surpassed 50,000 in July, more than double the prior year
F4C cirrhosis Phase III trial expected to read out in 2027

Madrigal Pharmaceuticals reported second-quarter Rezdiffra net sales of $364.3 million, a 71% increase from a year earlier, as the company expanded its patient base for the first approved treatment for metabolic dysfunction-associated steatohepatitis.

"Demand for Rezdiffra remains strong," Chief Executive Officer Bill Sibold said on the earnings call. He said prescriptions continue to be driven primarily by hepatologists and gastroenterologists, while the company is still early in its effort to reach endocrinologists, which began in the fourth quarter of 2025.

The company ended the quarter with more than 49,000 active patients on Rezdiffra, more than double the level reported a year earlier, and surpassed 50,000 in early July. Trailing 12-month net sales reached nearly $1.3 billion. The U.S. addressable market for diagnosed F2/F3 MASH patients treated by target specialists grew to approximately 460,000 patients at the end of 2025, compared with 315,000 at the end of 2023, as disease awareness and diagnosis rates improve.

Madrigal reported a net loss of $57.9 million for the quarter, wider than the $42.3 million loss in the prior-year period, pressured by a $25 million upfront payment tied to the in-licensing of MGL0795 from Arrowhead Pharmaceuticals and higher commercial spending. Research and development expense rose to $91.2 million from $54.1 million, while selling, general and administrative expense increased to $289.4 million from $196.9 million, reflecting the endocrinology field-force expansion and direct-to-consumer marketing. Cash, restricted cash and marketable securities declined to $838.9 million from $988.6 million at year-end 2025.

The company is conducting the event-driven Phase III MAESTRO-NASH OUTCOMES trial in patients with well-compensated MASH cirrhosis, known as F4C, and expects the study to read out in 2027. No approved therapy currently exists for F4C MASH. Madrigal has built a pipeline of more than 10 programs, including four clinical-stage assets. It began dosing its oral GLP-1 candidate, MGL-2086, in a Phase I study in June and plans to initiate Phase II studies in 2027 evaluating its DGAT2 inhibitor ervogastat with resmetirom and a combination of resmetirom with MGL0795.

The strong commercial momentum positions Madrigal as the dominant player in the early-stage MASH market, which Sibold estimates remains at roughly 10% diagnosis and about 10% penetration among diagnosed patients. Investors will watch for the F4C cirrhosis data readout in 2027, which could open a new patient population and extend Rezdiffra's patent protection into the 2040s.

This article is for informational purposes only and does not constitute investment advice.