Madrigal's Rezdiffra Hits $1.3B Run Rate as MASH Pipeline Expands

Rezdiffra reached an approximately $1.3 billion trailing-12-month revenue run rate in the second quarter of 2026, with revenue up 71% year over year to $364 million and more than 49,000 active patients.

Madrigal is expanding its MASH pipeline to 10 assets, primarily designed for combination use with Rezdiffra, including programs targeting weight loss, liver-fat reduction and genetically driven disease.

Upcoming Phase 3 data could support full approval in F2-F3 disease and expand Rezdiffra’s use into F4 compensated cirrhosis, potentially doubling its U.S. addressable market; international sales may remain limited in 2026 due to reimbursement challenges.

Madrigal Pharmaceuticals NASDAQ: MDGL said Rezdiffra continued to post strong commercial growth in the second quarter of 2026, while the company expanded its development pipeline around the MASH therapy and prepared for several potential clinical catalysts.

Speaking at a Canaccord Genuity event, Chief Financial Officer Mardi Dier said the company reported $364 million in second-quarter revenue, representing a 71% increase from the comparable period a year earlier.

Rezdiffra’s trailing-12-month revenue run rate was approximately $1.3 billion after nine quarters on the market, she said.

Dier said Madrigal had more than 49,000 active patients using Rezdiffra at the end of the second quarter and crossed the 50,000-patient mark in early July.

While Madrigal does not provide formal revenue guidance, she said the company was comfortable with consensus expectations for growth from the second to third quarter and from the third to fourth quarter of 2026.

“This is putting us on a trajectory of a mega blockbuster,” Dier said, adding that the company sees Rezdiffra as a long-term growth opportunity in a MASH market that remains early in its development.

Chief Commercial Officer Carole Huntsman said Madrigal established a broad group of prescribers early in Rezdiffra’s launch, surpassing 10,000 prescribers last year and continuing to add new prescribers regularly.

The company is now focused on increasing prescribing depth, she said.

Huntsman said physicians have reported that Rezdiffra has performed above their expectations in clinical practice, citing its liver-directed efficacy, once-daily oral dosing and tolerability profile.

She also pointed to data discussed during the company’s earnings call that showed efficacy across patient subtypes.

Addressing competition, Huntsman said Madrigal has not observed a significant negative impact on Rezdiffra from Wegovy’s approval in MASH.

She characterized Wegovy as more of a background therapy, noting that less than 1% of weekly Wegovy prescriptions are written by hepatologists or gastroenterologists for MASH patients, according to the company.

“We welcome competition,” Huntsman said. “Competition helps grow the market” by increasing education among providers and patients.

Madrigal has expanded from a pipeline consisting of Rezdiffra in two indications to a portfolio of 10 assets, Dier said.

The company spent less than $300 million upfront to build that pipeline and expects to use the assets primarily in combination with Rezdiffra.

Chief Medical Officer David Soergel outlined the rationale for several programs.

MGL-2086, a small-molecule GLP-1 agonist based on an orforglipron scaffold, is intended to deliver modest weight loss that could enhance Rezdiffra’s anti-fibrotic eff...