Madrigal Pharmaceuticals posts $364m Q2 Rezdiffra sales, up 71%
Madrigal Pharmaceuticals has reported second-quarter 2026 net revenues of $364.3 million from its MASH therapy Rezdiffra (resmetirom), a 71% increase on the $212.8 million recorded in the same period a year earlier. The Pennsylvania-based biopharmaceutical company said that more than 49,000 patients were on treatment as of 30 June 2026, more than double the figure from the second quarter of 2025, with the company adding that it has since crossed the 50,000-patient threshold.
Rezdiffra's trailing-12-month net sales have now reached approximately $1.3 billion. Chief executive Bill Sibold described the company as being "still at the beginning of one of the largest opportunities in biotechnology," pointing to persistently low rates of diagnosis and treatment in MASH as the primary driver of growth potential.
Pipeline and IP
Despite the revenue growth, Madrigal reported a net loss of $57.9 million for the quarter, or $1.99 per diluted share, compared with a net loss of $42.3 million in Q2 2025. Total operating expenses rose to $420.6 million, with SG&A spending of $289.4 million reflecting ongoing commercial investment including a direct-to-consumer campaign and an expanded endocrinology field force. R&D expenses climbed to $91.2 million, partly due to $25 million in one-time business development costs.
On the pipeline front, the company initiated Phase 1 dosing of MGL-2086, an oral small-molecule GLP-1 receptor agonist and orforglipron derivative, in healthy volunteers during June. Madrigal is developing the candidate as a potential combination partner for Rezdiffra, citing data from the Phase 3 MAESTRO-NASH trial showing that even modest weight loss of 5% or more can enhance Rezdiffra's antifibrotic efficacy. The first step is a single ascending dose study to characterise safety and dose response.
The company also strengthened its intellectual property position, with the US Patent and Trademark Office issuing three new resmetirom patents. These include a patent covering Rezdiffra's use in well-compensated cirrhosis (F4c), which is expected to provide protection into 2042, and two patents linked to the currently approved F2-F3 label, one of which extends into 2045.
Market context
Rezdiffra's rapid uptake underlines the scale of unmet need in MASH, a condition the company estimates affects a very large population but remains significantly underdiagnosed. The drug received approval from both the FDA and the European Commission as the first licensed therapy for MASH with moderate to advanced fibrosis, which provides a meaningful first-mover advantage in a market where no other agent has reached approval for the same indication.
The oral GLP-1 combination strategy is clinically and commercially logical. Injectable GLP-1 receptor agonists, including semaglutide, have already demonstrated meaningful liver-related benefits in MASH patients, and Novo Nordisk is conducting late-stage trials in the indication. An oral, liver-directed combination product could offer a differentiated profile, though MGL-2086 remains at an early clinical stage and the competitive timeline is long.
Madrigal closed the quarter with $838.9 million in cash and marketable securities, down from $988.6 million at year-end 2025, a trajectory that reflects the scale of commercial investment required to sustain Rezdiffra's growth. The next clinical milestone to watch is the ongoing Phase 3 outcomes trial in compensated MASH cirrhosis (F4c), where positive data would support a label expansion and further solidify Rezdiffra's position as the foundational therapy in the disease.