Madrigal’s Rezdiffra Q4 Net Sales $321M as Patients Reach 36,250
Madrigal ended Q4 2025 with 36,250 patients on Rezdiffra, up from 29,500 in Q3, driving $321 million in quarterly net sales, more than triple last year. It reported nearly $958 million in full-year sales, projects high-30% gross-to-net and is building a more than 10-program combination-focused pipeline.
1. Commercial Performance
Rezdiffra patient count rose to over 36,250 at the end of Q4 2025 from more than 29,500 in Q3, reflecting net new starts and discontinuations. Quarterly net sales of $321 million were more than triple the prior-year period, supported by prescriber education, expanded care pathways and contracting for access.
2. Financial Outlook
Madrigal closed Q4 with approximately $988.6 million in cash and equivalents to fund ongoing launch and pipeline activities. Management anticipates gross-to-net in the high-30% range for 2026 due to payer contracting, expects SG&A to increase while R&D remains roughly flat.
3. Pipeline Expansion
The company has advanced a combination-focused pipeline with over 10 programs, including an oral GLP-1 candidate (MGL-2086), DGAT2 inhibitor ervogastat and multiple liver-targeted siRNAs. Rezdiffra’s patent exclusivity has been extended to 2045, anchoring future combo strategies.
4. Outcomes Trial Plans
Madrigal is conducting a compensated MASH cirrhosis (F4c) outcomes study aiming to demonstrate prevention of decompensation. Event accrual is tracking within expected 5%–10% annual rates, with full outcomes data anticipated in 2027.