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Here are 1-3 brief analogies for Madrigal Pharmaceuticals (MDGL):

• Madrigal Pharmaceuticals is like Vertex Pharmaceuticals, but focused on liver diseases, bringing a first-in-class treatment for NASH to market.
• Madrigal Pharmaceuticals is like Gilead Sciences was when it revolutionized Hepatitis C treatment, but for major liver diseases such as NASH.

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• Resmetirom (Rezdiffra): An oral medication approved for the treatment of adults with noncirrhotic non-alcoholic steatohepatitis (NASH), now known as metabolic dysfunction-associated steatohepatitis (MASH), with moderate to advanced fibrosis.

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Madrigal Pharmaceuticals (MDGL), like most pharmaceutical companies, sells its prescription drugs primarily to other companies and institutions, not directly to individual patients. Their major customers are the pharmaceutical wholesale distributors who then supply pharmacies, hospitals, and clinics. These distributors facilitate the widespread availability of drugs to healthcare providers and, ultimately, to patients.

While Madrigal Pharmaceuticals may not specifically name individual customers in its public filings beyond referring to the "wholesale channel," the primary wholesale distributors in the U.S. healthcare system through which Madrigal Pharmaceuticals' product Rezdiffra would typically be distributed include:

• McKesson Corporation (Symbol: MCK)
• AmerisourceBergen Corporation (Symbol: ABC)
• Cardinal Health, Inc. (Symbol: CAH)

These three major wholesalers collectively account for a significant portion of pharmaceutical product distribution in the United States and are the critical partners for pharmaceutical companies in getting their products to market.

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Bill Sibold, Chief Executive Officer and Director

Mr. Sibold has over 30 years of experience in the biopharmaceutical industry. Prior to joining Madrigal in September 2023, he served as Executive Vice President, Specialty Care of Sanofi and President, Sanofi North America, where he led a global organization and was responsible for the launch of Dupixent. He previously served as Chief Commercial Officer of Avanir Pharmaceuticals, President and CEO of Lycera Corp., and Senior Vice President, U.S. Commercial for Biogen.

Mardi C. Dier, Chief Financial Officer and Senior Vice President

Ms. Dier was appointed CFO in February 2024 and brings over 20 years of executive financial leadership experience in the biopharmaceutical industry. She previously held CFO positions at Portola Pharmaceuticals (which was acquired by Alexion), Ultragenyx Pharmaceutical, Inc., and Acelyrin, Inc. Prior to Portola, she was Vice President of Investor Relations at Chiron Corporation until its acquisition by Novartis.

Rebecca Taub, M.D., Founder and Senior Scientific and Medical Advisor

Dr. Taub is a founder of Madrigal Pharmaceuticals and currently serves as Senior Scientific and Medical Advisor, transitioning from her previous role as Chief Medical Officer and President of Research & Development in April 2025. She served as CEO of the privately-held Madrigal Pharmaceuticals from its inception through its merger with Synta Pharmaceuticals Corp. Dr. Taub also held senior R&D leadership roles at VIA Pharmaceuticals, Hoffmann-La Roche, Bristol-Myers Squibb Co., and DuPont Pharmaceutical Company. Before her pharmaceutical career, she was a tenured Professor of Genetics and Medicine at the University of Pennsylvania.

Carole Huntsman, Chief Commercial Officer

Ms. Huntsman has over 30 years of biopharmaceutical experience with 35 product launches across various therapeutic areas. Before joining Madrigal, she was Senior Vice President, Head of Specialty Care North America and U.S. Country Lead at Sanofi, where she was involved in many specialty product launches, including Dupixent. She also held commercial roles at Sanofi Genzyme, EMD Serono, Pfizer, and Muro Pharmaceuticals.

Mark Barrett, Chief Business Officer

Mr. Barrett joined Madrigal in January 2024 and has over 25 years of biopharmaceutical leadership experience, with a focus on partnerships and acquisitions. He was previously a co-founder, Director, and CEO of Lassen Therapeutics. Mr. Barrett also served as an Entrepreneur in Residence at Frazier Healthcare Partners, where he concentrated on starting and financing new biotechnology companies.

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The key risks to Madrigal Pharmaceuticals (MDGL) are primarily centered around its dependence on its lead drug, the evolving competitive landscape in the MASH treatment market, and ongoing financial challenges inherent to a clinical-stage biotechnology company.

1. Concentration and Pipeline Risk (Reliance on Rezdiffra): Madrigal Pharmaceuticals' financial performance is heavily reliant on the success of Rezdiffra (resmetirom), its primary drug for Metabolic Dysfunction-Associated Steatohepatitis (MASH). Rezdiffra received accelerated approval from the FDA, which means the company must conduct post-marketing studies to confirm clinical benefit; failure to meet these requirements could lead to regulatory actions or even the drug being withdrawn from the market. Any setbacks in the sales, efficacy, or further regulatory approvals for Rezdiffra would significantly impact the company. Madrigal also needs to diversify its pipeline to mitigate this concentration risk.
2. Market Competition: Despite Rezdiffra being the first FDA-approved treatment for MASH, the competitive landscape is rapidly evolving. There is a significant and growing threat from other companies developing MASH treatments, particularly the class of drugs known as GLP-1 agonists (such as Eli Lilly's tirzepatide and Novo Nordisk's semaglutide). These GLP-1 drugs are showing promising data for MASH and could pose a substantial challenge to Rezdiffra's commercial success and market share.
3. Financial Risks and Profitability Challenges: Madrigal Pharmaceuticals is a loss-making company, having reported negative earnings before interest and tax (EBIT) and negative free cash outflow over the last year. While the company maintains a strong cash position, it faces considerable challenges in achieving sustained profitability due to high research and development (R&D) expenses typical of the biotechnology sector. Analysts project the company to reach breakeven in 2026, indicating that current operations are still generating losses.

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• Viking Therapeutics (VKTX) - VK2809: This investigational oral thyroid hormone receptor-beta (THR-ß) agonist is in the same class as Madrigal's Resmetirom (Rezdiffra) and recently reported highly promising Phase 2b clinical trial results for the treatment of metabolic dysfunction-associated steatohepatitis (MASH). VK2809 demonstrated significant reductions in liver fat and a high proportion of patients achieving MASH resolution without worsening of fibrosis. As a direct competitor targeting the same mechanism, VK2809 poses a clear threat if it continues to show strong efficacy and safety in future trials, potentially challenging Resmetirom's first-mover advantage and market share.
• Novo Nordisk (NVO) - Semaglutide: Already a blockbuster drug for type 2 diabetes and obesity (Ozempic/Wegovy), semaglutide (a GLP-1 receptor agonist) is in late-stage (Phase 3) clinical trials for MASH. Phase 2 data has shown significant improvements in MASH resolution. Given its established market presence, broad metabolic benefits, and potential efficacy in MASH, semaglutide could capture a substantial portion of the MASH market, especially among patients with co-morbid obesity and diabetes, potentially limiting the uptake of drugs like Resmetirom.

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Madrigal Pharmaceuticals' main product is Rezdiffra (resmetirom), which is approved for the treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis).

Madrigal Pharmaceuticals estimates the theoretical addressable market opportunity for Rezdiffra to be approximately $15 billion in the U.S., targeting an estimated 315,000 diagnosed patients with MASH with significant fibrosis (F2-F3) who are under the care of liver specialists.

Broader market size estimates for the non-alcoholic steatohepatitis (NASH), now known as MASH, treatment market include:

• **U.S. Market:** The U.S. non-alcoholic steatohepatitis treatment market was valued at approximately $4.56 billion in 2024 and is projected to reach $32.55 billion by 2032, with a compound annual growth rate (CAGR) of 27.88%. In 2023, the market size of MASH in the U.S. was approximately $1.51 billion and is expected to increase by 2034.
• **Global Market:** The global non-alcoholic steatohepatitis treatment market was valued at approximately $7.70 billion in 2024 and is expected to reach $55.52 billion by 2032, growing at a CAGR of 28.05%. Other estimates project the global market to exceed $96.64 billion by 2035, growing at a CAGR of more than 26.5% from its 2025 valuation of over $9.21 billion. The global NASH market is also estimated to reach $57.5 billion by 2033. The total market size for MASH in the 7MM (United States, Germany, Spain, Italy, France, United Kingdom, and Japan) was approximately $2.11 billion in 2023 and is projected to increase during the forecast period of 2024-2034.

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Madrigal Pharmaceuticals (MDGL) is expected to drive future revenue growth over the next 2-3 years through several key initiatives, primarily centered around its lead drug, Rezdiffra (resmetirom), and strategic pipeline expansion.

1. Continued Growth and Adoption of Rezdiffra in the U.S. Market: Rezdiffra, the first FDA-approved treatment for metabolic dysfunction-associated steatohepatitis (MASH), is experiencing strong demand and patient adoption in the United States. Madrigal Pharmaceuticals reported third-quarter 2025 net sales of $287.3 million for Rezdiffra, a 35% increase quarter-over-quarter, with over 29,500 patients on therapy by the end of September 2025. The company is focused on securing broad, first-line access for Rezdiffra through ongoing payer contracting discussions, aiming for no step-through requirements and improved utilization management criteria in 2026. Analysts forecast Madrigal's revenue to grow faster than the US market.
2. International Expansion, particularly in Europe: Madrigal has initiated the launch of Rezdiffra in Germany following conditional marketing authorization from the European Commission in August 2025, with plans to negotiate reimbursement procedures for other EU member states. This expansion into the European market represents a significant opportunity to reach a new patient population and contribute to revenue growth.
3. Potential Label Expansion for Rezdiffra into Compensated MASH Cirrhosis (F4c): The company is advancing the Phase 3 MAESTRO-NASH OUTCOMES trial, which is evaluating Rezdiffra in patients with compensated MASH cirrhosis (F4c). Positive results from this trial could lead to an expanded label for Rezdiffra, positioning it as the only treatment for F2 to F4 MASH and potentially unlocking substantial revenue from this advanced and underserved patient population.
4. Strategic Pipeline Expansion with Oral GLP-1 Receptor Agonist: Madrigal has entered into a global licensing agreement with CSPC Pharma to add an oral GLP-1 receptor agonist (SYH2086) to its pipeline. This asset is intended to be developed in combination with Rezdiffra, aiming to enhance efficacy and maintain tolerability, thereby creating a new therapeutic option and a future revenue stream. Trials for this new oral GLP-1 are expected to begin in early 2026.

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Share Issuance

• In March 2024, Madrigal Pharmaceuticals announced the pricing of an upsized public offering, which was expected to generate approximately $600 million in gross proceeds from the sale of common stock and pre-funded warrants.
• In December 2022, the company raised $259 million in gross equity from issuances, including $159 million from its At-The-Market (ATM) Program sales and a $100 million securities purchase agreement with institutional investors.
• The number of shares outstanding has seen consistent increases, with a 6.98% rise in one year (as of late 2024/early 2025) and annual net total equity issued being $0.735 billion in 2024 and $0.53 billion in 2023.

Inbound Investments

• Madrigal Pharmaceuticals secured a $350 million initial term loan through a senior secured credit facility managed by Blue Owl Capital in November 2025.
• In December 2022, the company obtained an additional $50 million in liquidity commitments under its Hercules Credit Facility following a clinical milestone.
• Paulson & Co. Inc., a major institutional investor, significantly increased its stake in Madrigal Pharmaceuticals by 10.38% on September 30, 2024, acquiring 192,000 shares at $212.22 per share.

Outbound Investments

• In November 2025, Madrigal Pharmaceuticals closed a global licensing agreement with CSPC Pharma to integrate an oral GLP-1 into its pipeline.
• While no major acquisitions of other companies were explicitly detailed, the company's public offering in March 2024 indicated that net proceeds might be used for potential acquisitions or licensing of new technologies and ex-U.S. commercialization opportunities.

Capital Expenditures

• Capital expenditures were approximately -$1.05 million in the last 12 months as of late 2025.
• Annual capital expenditures were around $1.46 million in 2024, $1.48 million in 2023, $0.22 million in 2022, and $0.21 million in 2021.
• Proceeds from the March 2024 public offering were intended, in part, for general corporate purposes, including capital expenditures.