Madrigal Pharmaceuticals' Q2 2025: Contradictions Surrounding GLP-1 Market Impact and Rezdiffra Growth

GLP-1 market disruption and Rezdiffra growth, impact of GLP-1 entrance on growth, gross to net discount range, GLP-1 combination strategy and market impact, and gross to net dynamics and expectations are the key contradictions discussed in Madrigal Pharmaceuticals' latest 2025Q2 earnings call.



Rezdiffra Launch Performance:
- Madrigal Pharmaceuticals reported net sales of $213 million in Q2 2025, up 55% quarter-over-quarter.
- The U.S. Rezdiffra net sales are now annualizing at well over $800 million.
- This growth is driven by strong patient demand, with over 23,000 patients on Rezdiffra at the end of the quarter, and strong physician adoption, with 80% of top target prescribers now prescribing Rezdiffra.

International Expansion and Patent Extension:
- Madrigal expects to launch Rezdiffra in Germany in the second half of 2025 following a positive CHMP opinion for EU approval.
- The new U.S. patent provides protection to 2045, extending its patent life significantly and adding potential future revenue.
- This patent extension is based on clear and compelling findings from the MAESTRO NASH trial, which shows optimized efficacy and safety for Rezdiffra, supporting strategic flexibility for future growth.

Clinical and Market Potential:
- The company's F4C data showed liver stiffness reduction of 6.7 kilopascals and a 35% regression from F4 to F3 cirrhosis in patients.
- There are approximately 245,000 patients with compensated NASH cirrhosis in the U.S., representing a potential doubling of Rezdiffra's market opportunity.
- This unmet need in compensated cirrhosis, along with Rezdiffra's proven mechanism of action, supports its potential as a foundational therapy for this population.

Business Development and Financial Health:
- Madrigal entered into a nondilutive financing agreement for $500 million, highlighting its financial strength.
- The new oral GLP-1 license agreement will support clinical development and further enhance Madrigal's NASH pipeline.
- The company's strategic focus on long-term growth is reflected in its capital investments, ensuring it is well-resourced for future expansion.