Madrigal surges as Rezdiffra sales smash estimates, approach $1bn
Full-year 2025 revenue of $958.4M reflects 432% growth for the first FDA-approved MASH treatment
Madrigal Pharmaceuticals shares rallied in Thursday trading after the company reported fourth-quarter sales of its liver disease treatment Rezdiffra that far exceeded Wall Street expectations, capping a year of explosive growth for the first approved therapy for metabolic dysfunction-associated steatohepatitis.
The company reported fourth-quarter Rezdiffra net sales of $321.1 million, crushing analyst estimates that ranged between $310 million and $313 million. Full-year 2025 sales reached $958.4 million, a 432% increase from the $180.1 million recorded in the prior year, with more than 36,250 patients on therapy by year-end.
The results represent a remarkable acceleration for Madrigal, which secured accelerated FDA approval for Rezdiffra in March 2024 as the first treatment specifically for noncirrhotic MASH with moderate to advanced liver fibrosis. The drug's rapid commercial adoption has positioned Madrigal at the forefront of a market projected to reach $20.3 billion by 2032.
Chief Executive Bill Sibold signaled continued momentum for 2026, stating the company expects "another year of robust net sales growth driven by broad first-line access, increasing disease awareness and the outstanding real-world experience with Rezdiffra reported by patients and providers."
Madrigal's financial position remains substantial, with cash, cash equivalents, restricted cash, and marketable securities totaling $988.6 million as of December 31, 2025. The strong balance sheet supports an ambitious pipeline expansion that now encompasses more than 10 programs.
The company recently licensed global rights to six pre-clinical siRNA programs, with IND-enabling activities for initial candidates expected to begin this year. Madrigal also expanded its MASH portfolio through an exclusive global license for ervogastat, a Phase 2 oral DGAT-2 inhibitor acquired from Pfizer, and plans to conduct a drug-to-drug interaction study with Rezdiffra while consulting with regulators on a Phase 2 combination trial.
An oral GLP-1 candidate, MGL-2086, licensed in September 2025, is expected to enter clinical trials in the second quarter of 2026, positioning Madrigal to compete directly in the lucrative GLP-1 market. The move comes as Novo Nordisk's Wegovy received FDA approval for MASH in August 2025, marking the second approved therapy for the liver disease and the first GLP-1 drug to secure this indication.
Analysts have largely dismissed concerns about GLP-1 competition, noting Rezdiffra's high patient retention and potential for synergy with GLP-1 therapies. According to recent analyst commentary, approximately 25% of Rezdiffra patients are already taking GLP-1 medications for diabetes or obesity.
The company's stock performance reflects growing investor confidence, with shares up more than 85% over the past year. The stock currently trades around $491, below the consensus analyst target price of $671.07, suggesting significant upside potential. Of 16 analysts covering the stock, 14 rate it a buy while two recommend hold.
Prescription growth momentum remained strong exiting the fourth quarter, with 39% growth in new prescriptions and 15% growth in total prescriptions quarter-over-quarter. This translated to a 21% sequential sales expansion, according to recent analysis.
Management has emphasized that significant market penetration runway remains, noting that only about 10% of the diagnosed MASH population has been reached to date. Geographic expansion into Europe, including sales commencing in Germany in September 2025, is expected to contribute to continued growth throughout 2026.