Company Description
Madrigal Pharmaceuticals, Inc. (Nasdaq: MDGL) is a biopharmaceutical company focused on delivering novel therapeutics for metabolic dysfunction-associated steatohepatitis (MASH), a serious liver disease with high unmet medical need. The company’s work is centered on developing and commercializing therapies that address key underlying causes of MASH and its complications.
Madrigal’s lead medication is Rezdiffra (resmetirom), described as a once-daily, oral, liver-directed thyroid hormone receptor-β (THR-β) agonist. According to company disclosures, Rezdiffra is designed to target key drivers of MASH by increasing the cell’s ability to process fat via mitochondrial biogenesis and improving liver-related biomarkers. Rezdiffra is indicated, in conjunction with diet and exercise, for adults with MASH or nonalcoholic steatohepatitis (NASH) with moderate to advanced liver fibrosis (consistent with stages F2 to F3) and without cirrhosis, under an approval framework based on histologic improvement of MASH/NASH and fibrosis.
Company statements note that Rezdiffra is the first and only medication approved by both the U.S. Food and Drug Administration (FDA) and the European Commission for the treatment of MASH with moderate to advanced fibrosis (F2 to F3). Madrigal also reports that Rezdiffra is the first approved medication for the treatment of MASH in the U.S. and Europe, reflecting the company’s focus on this disease area.
Business focus and therapeutic area
Madrigal operates in the pharmaceutical preparation manufacturing industry within the broader manufacturing sector, with a specific focus on liver disease. Its disclosures emphasize MASH, formerly known as nonalcoholic steatohepatitis (NASH), as a progressive condition that can lead to cirrhosis, liver failure, liver cancer, need for liver transplantation, and premature mortality. Company materials highlight that MASH is a leading cause of liver transplantation in women and a major cause of liver transplantation overall in the U.S., and that it is a rapidly growing indication for liver transplantation in Europe.
The company positions its pipeline and commercial strategy around the spectrum of MASH, including patients with moderate to advanced fibrosis (F2–F3) and those with compensated MASH cirrhosis (F4c). An ongoing Phase 3 outcomes trial is evaluating Rezdiffra for the treatment of compensated MASH cirrhosis, a population described as having a significantly elevated risk of liver-related mortality.
Rezdiffra clinical profile and role in MASH care
Across multiple company communications, Madrigal reports that in the pivotal Phase 3 MAESTRO-NASH biopsy trial, Rezdiffra achieved both fibrosis improvement and MASH resolution primary endpoints. The company also reports that Rezdiffra reduced liver stiffness, liver fat, liver enzymes, and atherogenic lipids, and improved health-related quality of life measures in clinical studies. In an open-label extension of the MAESTRO-NAFLD-1 trial, Madrigal describes durable improvements in noninvasive imaging tests and biomarkers over two years of treatment, with attenuation of benefits during treatment interruption and restoration of improvements when therapy resumed.
In patients with compensated MASH cirrhosis (F4c), Madrigal reports that Rezdiffra treatment in an open-label arm of MAESTRO-NAFLD-1 was associated with improvements in liver stiffness, fibrosis biomarkers, and markers related to clinically significant portal hypertension risk. Company summaries indicate that these effects were observed even in more advanced patients and that safety findings were consistent with previous studies, with Rezdiffra described as well tolerated in this high-risk population. Madrigal also highlights improvements in disease-specific quality-of-life measures for patients with and without cirrhosis, sustained through two years of treatment in pooled analyses.
Pipeline and combination therapy strategy
Beyond Rezdiffra, Madrigal is expanding its MASH-focused pipeline. The company has entered into a global license agreement with CSPC Pharmaceutical Group Limited for an oral glucagon-like peptide-1 (GLP-1) receptor agonist, referred to as MGL-2086 (formerly SYH2086), which Madrigal intends to develop in combination with Rezdiffra for MASH. Company disclosures describe this as part of a strategy to build a portfolio of complementary mechanisms anchored by Rezdiffra.
In a separate agreement, Madrigal announced an exclusive global license with Pfizer for ervogastat (PF-06865571), a clinical-stage, liver-directed, oral diacylglycerol O-acyltransferase 2 (DGAT-2) inhibitor. Madrigal describes DGAT-2 inhibition as blocking the final step in triglyceride assembly and storage, leading to lower hepatic triglycerides, reduced lipotoxic fat, and decreased inflammation in the liver. Company statements emphasize a scientific rationale for studying ervogastat in combination with Rezdiffra, noting that the two act on distinct yet complementary pathways involved in liver fat accumulation and fibrosis.
Through these licensing arrangements, Madrigal reports that it now has a broadened portfolio spanning several key pathways that it believes will define future MASH treatment approaches, including combination regimens. The company indicates plans for a drug–drug interaction study of ervogastat with Rezdiffra and consultation with the FDA on a Phase 2 combination trial design, as well as clinical development plans for its oral GLP-1 receptor agonist.
MASH disease context as presented by the company
In its communications, Madrigal provides extensive background on MASH. The company describes MASH as a serious liver disease that, once it progresses to moderate to advanced fibrosis (F2–F3), is associated with a markedly higher risk of adverse liver outcomes and liver-related mortality compared with patients without fibrosis. For patients who progress to cirrhosis, Madrigal cites data indicating a substantially higher risk of liver-related mortality, underscoring the importance of treating MASH before complications of cirrhosis develop.
Madrigal also notes that MASH is an independent driver of cardiovascular disease, described as the leading cause of mortality for patients with MASH. The company expects that as disease awareness and prevalence increase, the number of diagnosed patients with moderate to advanced fibrosis or compensated MASH cirrhosis (F2–F4c) will grow, which aligns with its focus on therapies across this spectrum.
Commercialization and geographic footprint as described
Madrigal reports that Rezdiffra has been launched in the United States and, following conditional marketing authorization by the European Commission, in at least one European Union country. Company communications specifically mention a launch in Germany after European Commission authorization based on the MAESTRO-NASH trial results. Madrigal characterizes Rezdiffra as the first and only approved therapy for MASH in the European Union.
In financial updates, the company has highlighted growing product revenue from Rezdiffra and increasing numbers of patients and prescribers. These disclosures frame Rezdiffra as a foundational therapy in MASH care and a central driver of Madrigal’s business, though detailed financial metrics and projections are time-sensitive and are best reviewed directly in the company’s SEC filings and earnings releases.
Capital structure and financing arrangements
Madrigal is a publicly traded company listed on the Nasdaq under the symbol MDGL. The company has disclosed entering into a senior secured credit facility with funds managed by Blue Owl Capital Corporation. Under a Financing Agreement, the lenders committed to senior secured term loan facilities with an initial term loan funded at closing and additional delayed draw and incremental term loan capacity, subject to conditions. The company used proceeds from the initial term loan to repay and terminate a prior loan and security agreement, releasing related security interests and guarantees.
The Financing Agreement includes covenants, representations, warranties, and events of default typical for such arrangements, including a requirement for Madrigal and its guarantor subsidiaries to grant a first-priority security interest in substantially all of their assets, subject to customary exceptions, and to maintain a specified minimum unrestricted cash balance. The term loans have a stated maturity date in the future and bear interest at rates tied to a base rate or Term SOFR plus specified margins, as described in the company’s 8-K filing.
Governance and shareholder matters
Through its proxy-related disclosures, Madrigal reports holding an annual meeting of stockholders at which Class III directors were re-elected for terms extending to a future annual meeting. Stockholders also voted on the ratification of the company’s independent registered public accounting firm, advisory approval of executive compensation, and the frequency of future advisory votes on executive compensation. The company’s board subsequently determined to hold such advisory votes on an annual basis, consistent with the outcome of the frequency vote.
Risk and regulatory disclosures
In its press releases and SEC filings, Madrigal consistently includes forward-looking statements disclaimers. These statements highlight risks related to regulatory approvals, clinical trial execution and outcomes, market demand for Rezdiffra, financing obligations, competition, cybersecurity, and changes in laws and regulations. The company refers investors to its Annual Report on Form 10-K and subsequent SEC filings for detailed risk factor discussions and cautions against undue reliance on forward-looking statements.
FAQs about Madrigal Pharmaceuticals, Inc. (MDGL)
- What does Madrigal Pharmaceuticals, Inc. do?
Madrigal Pharmaceuticals, Inc. is a biopharmaceutical company that focuses on delivering novel therapeutics for metabolic dysfunction-associated steatohepatitis (MASH), a liver disease with high unmet medical need. Its lead product, Rezdiffra (resmetirom), is a once-daily, oral, liver-directed THR-β agonist designed to target key underlying causes of MASH. - What is Rezdiffra and who is it for?
Rezdiffra is a prescription medicine used along with diet and exercise to treat adults with MASH or NASH with moderate to advanced liver scarring (fibrosis) and without cirrhosis of the liver. The indication is based on improvement of MASH/NASH and fibrosis, with ongoing studies to confirm clinical benefit. - How does Rezdiffra work according to company descriptions?
Madrigal describes Rezdiffra as a liver-directed thyroid hormone receptor-β agonist that increases the cell’s ability to process fat via mitochondrial biogenesis and improves multiple noninvasive imaging tests and biomarkers related to liver fat, liver stiffness, and lipids in clinical studies. - What makes Rezdiffra notable in MASH treatment?
Company materials state that Rezdiffra is the first and only medication approved by both the FDA and the European Commission for the treatment of MASH with moderate to advanced fibrosis (F2 to F3), and the first approved medication for MASH in the U.S. and Europe. Madrigal highlights this as addressing a significant unmet need. - What other pipeline assets does Madrigal have?
Madrigal has licensed an oral GLP-1 receptor agonist (MGL-2086) from CSPC Pharma and ervogastat, a liver-directed oral DGAT-2 inhibitor, from Pfizer. The company plans to develop these assets in combination with Rezdiffra for potential additive benefit in MASH. - How is Madrigal approaching combination therapy in MASH?
The company states that MASH is a complex disease likely to require multiple treatment approaches. Madrigal’s strategy is to use Rezdiffra as an anchor therapy and add complementary mechanisms, such as GLP-1 receptor agonism and DGAT-2 inhibition, to create combination regimens that may enhance antisteatotic and antifibrotic effects. - What clinical trials are ongoing for Rezdiffra?
Madrigal reports an ongoing Phase 3 outcomes trial evaluating Rezdiffra for the treatment of compensated MASH cirrhosis (F4c). It also references the MAESTRO-NASH and MAESTRO-NAFLD programs, including open-label extensions and analyses of imaging, biomarkers, and quality-of-life outcomes. - How does Madrigal describe the burden of MASH?
The company describes MASH as a leading cause of liver transplantation in women and a major cause of liver transplantation overall in the U.S., and as a rapidly growing indication for transplantation in Europe. It notes that patients with F2–F3 fibrosis or cirrhosis face substantially higher risks of liver-related mortality and that MASH is an independent driver of cardiovascular disease. - On which exchange does Madrigal trade and under what ticker?
Madrigal Pharmaceuticals, Inc. trades on the Nasdaq under the ticker symbol MDGL, as indicated in its press releases and SEC filings. - Where can investors find more detailed information about Madrigal’s risks and financials?
Madrigal directs investors to its submissions filed with the U.S. Securities and Exchange Commission, including its Annual Report on Form 10-K and subsequent filings, for detailed information on financial results, risk factors, and other material disclosures.
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Short Interest History
Short interest in Madrigal Pharmac (MDGL) currently stands at 3.7 million shares, down 0.2% from the previous reporting period, representing 17.7% of the float. This moderate level of short interest indicates notable bearish positioning. With 13.1 days to cover, it would take significant time for short sellers to close their positions based on average trading volume.
Days to Cover History
Days to cover for Madrigal Pharmac (MDGL) currently stands at 13.1 days, down 6.8% from the previous period. This elevated days-to-cover ratio indicates it would take over two weeks of average trading volume for short sellers to exit their positions, suggesting potential for a short squeeze if positive news emerges. The days to cover has increased 50.1% over the past year, indicating improving liquidity conditions. The ratio has shown significant volatility over the period, ranging from 7.4 to 17.0 days.