Madrigal Pharmaceuticals, Inc. reports strong growth in Rezdiffra sales in Q4 2025; the first full year of launch is approaching $1 billion in net sales
Madrigal Pharmaceuticals, Inc. (NASDAQ: MDGL) reported fourth quarter 2025 results showing continued commercial success for its lead product Rezdiffra (resmetirom), with quarterly product revenue increasing year over year as the company completes the first full year of its metabolic dysfunction–associated steatohepatitis (MASH) launch. The company also reported progress across its MASH pipeline and maintained a strong financial position.
Financial performance for Q4 2025
Product revenue in Q4 2025 has been reached $321.1 millioncompared to $103.3 million in Q4 2024which shows the expansion of Rezdiffra’s definition and wider market reach during the first year of sales. Selling expenses increase in line with higher volumes $24.4 millionwhile operating costs are rising as the company continues to invest in R&D and commercial infrastructure.
Research and development expenses increased to $116.3 million in Q4 2025 from $25.6 million a year earlier, reflecting clinical activities and pipeline expansion. Selling, general and administrative expenses increased to $240.0 million from $141.2 million in Q4 2024 as commercial activities are measured. The company reported a a total loss of $58.6 million per quarter, compared to a a total loss of $59.4 million in the prior year period, reflecting higher operating costs offset by higher revenues.
Summary of the full year 2025
In the full year of 2025, Madrigal reported Rezdiffra’s total sales were $958.4 millionmarking the first full year of commercial launch. Net sales for the quarter accelerated throughout the year, rising since $103.3 million in Q4 2024 to $321.1 million in Q4 2025showing steady growth as patient adoption increases.
The company ended in 2025 with $988.6 million in cash, cash equivalents, restricted cash and marketable securitiesproviding financing to support ongoing sales and pipeline development. Management has indicated that capital will continue to be allocated to the expansion of the Rezdiffra franchise and the development of therapeutic combinations and next-generation products.
Trade and market development
The presentation highlighted the continued expansion of the treated patient base and diagnosis rates of MASH. The number of patients on Rezdiffra is expected to grow steadily in 2024 and 2025, along with the growth of the target population of F2/F3 in the United States. The company reported entry into all special procedures and progress in obtaining coverage and access by commercial payers.
Rezdiffra remains the first approved treatment for MASH. Management has positioned the product as a primary treatment for F2/F3 disease, with ongoing efforts to increase the number of patients treated through physician education, integration of practice-level care, and patient identification programs.
Pipeline development and integration strategy
Beyond the commercial franchise, Madrigal featured a growing MASH pipeline assembled by Rezdiffra. Important programs include combination approaches with an oral DGAT-2 inhibitor (ervogastat), oral GLP-1 (MGL-2086)again siRNA-based targetingaimed at addressing the underlying disease mechanisms. The company plans to initiate drug interaction studies in 2026 and develop combination studies thereafter, subject to regulatory discussions.
The company is also pursuing a potential expansion into compensated MASH cirrhosis (F4c), with outcome data expected in 2027, which could significantly increase the number of treatable patients.
Operating expenses and balance sheet
Operating expenses increase through 2025 due to expanded clinical development, marketing investments, and stock-based compensation. Despite continued losses, the company’s balance sheet remained strong, with sufficient cash flow to fund operations and development in the near and medium term.
Industry status and outlook
The MASH treatment market is in the early stages of development, diagnostic rates and professional care methods are increasing. Madrigal’s strategy focuses on developing Rezdiffra as a primary treatment while developing drug combinations to address a variety of diseases over time. The company expects continued growth in net sales of Rezdiffra in 2026 as the treated patient base grows and market awareness improves.
Summary
Madrigal Pharmaceuticals reported strong year-over-year growth in product revenue for Q4 2025, driven by increased acquisition of Rezdiffra, and sales of nearly $1 billion in the first full year of launch. Operating costs increased in line with commercial and pipeline investments, while capital expenditures remained strong. The company continues to advance its combination strategies and pipeline to support long-term growth in the evolving MASH treatment market.
