Resmetirom

It seems there’s room for two in the MASH market. When Novo Nordisk’s blockbuster weight loss drug Wegovy won approval in August 2025 to treat the fatty liver disease, some investors thought it would put competitive pressure on Madrigal Pharmaceuticals’ liver-targeted therapy Rezdiffra, causing Madrigal’s stock to dip that day. Madrigal was the first company to market a drug in the US for MASH in 2024, and its launch was off to a strong start . But at the time in 2025, GLP-1s seemed like an “unstoppable” machine, said Cody Powers, principal at the consulting firm ZS. The expectation was that GLP-1s might chip away at some of Rezdiffra’s early demand. But it seems that Madrigal has managed to avoid that outcome. “What’s really transpired is that is not the case. In fact, it’s the opposite,” Powers said. Madrigal executives said last week that April was its best month for new patient starts since launch. More than 42,250 patients were using Rezdiffra at the end of the first quarter, which is 2.5 times higher than the same time last year. CEO Bill Sibold said during the company’s first-quarter earnings call that patients are using Wegovy for MASH, “but certainly not to the detriment of Rezdiffra.” In fact, he said, Novo’s efforts have helped Rezdiffra’s case by creating more awareness for the little-known disease, for which the diagnosis rate is just over 10%. “By having a product, by having more than one company, the market’s growing,” Sibold said on the call. Leerink analyst Thomas Smith told Endpoints News that Novo’s approval is likely to create a tailwind for Madrigal as it continues to drive more patients to a diagnosis. With such a large, unaddressed market, there’s room for more than two winners — potentially even within the same class or through combination regimens, he said. Madrigal executives said about a quarter of all patients who are prescribed Rezdiffra are also on a GLP-1 product, and more than half have been previously exposed to a GLP-1. Smith said many of those patients receive a GLP-1 for other related conditions like diabetes, obesity or sleep apnea, and then receive a prescription for Rezdiffra on top of it to address their MASH. Smith said that dynamic is likely to continue over the next several years, and noted that combination therapy could prove to be more effective than monotherapy. As Madrigal builds its pipeline, the company is looking for assets with combination potential. It is currently testing an oral GLP-1 in combination with Rezdiffra in Phase 1. “You do have some reason to believe that combination therapy is going to end up being more effective than monotherapy,” Smith said. “All of that is going to lead to, we think, a pretty massive market opportunity.”