MDGL · Madrigal Pharmaceuticals, Inc.

Madrigal Pharmaceuticals delivered robust Q1 2026 results with Rezdiffra net sales surging 127% year-over-year to $311.3 million, fueled by expanded patient access exceeding 42,250 individuals, a 2.5x increase from Q1 2025. This growth underscores strong physician adoption and sustained demand in the MASH market, which has nearly doubled to approximately 460,000 diagnosed patients with F2-F3 fibrosis. CEO Bill Sibold highlighted Rezdiffra's blockbuster status on a trailing 12-month basis and favorable market dynamics for continued expansion. Despite revenue gains, operating expenses climbed to $404.1 million from $216.6 million, driven by SG&A investments in commercial infrastructure, including endocrinology field force expansion and DTC marketing, alongside elevated R&D from a $54.3 million upfront payment for the ARO-PNPLA3 siRNA licensing from Arrowhead Pharmaceuticals. Cost of sales also rose to $26.8 million, reflecting scaling production. These factors contributed to a Q1 net loss of $94.4 million or $3.25 per share, wider than the prior year's $73.2 million or $2.61 per share, though adjusted for the one-time business development cost equates to $1.87 per share impact. Balance sheet remains solid with $817.9 million in cash and equivalents as of March 31, 2026, down from year-end 2025 but supportive of pipeline advancement, including MGL-2086 Phase 1 initiation in Q2 2026 and preclinical siRNA programs. Strategic moves like the PNPLA3-targeted asset, showing up to 46% liver fat reduction in Phase 1, position Madrigal to develop genetically tailored combination therapies, reinforcing leadership in MASH therapeutics with Rezdiffra's IP protection to 2045.