Madrigal Pharmaceuticals : MDGL 1Q26 Earnings Presentation

Published: 2026-05-06 08:12:28 ET MDGL

Published on 05/06/2026 at 08:12 am EDT

1Q26

Financial Results

May 6, 2026

Aroosha, patient ambassador

Advancement of 2026 Priorities Strengthen Madrigal's

Leadership in MASH, a Market with Exceptional Fundamentals

Maximizing the Value of Rezdiffra Building Our Pipeline

Delivering on

best-in-industry drug launch

Progressing toward

F4c indication expansion

Extending leadership

through industry-leading pipeline

Net Sales in LTM

of >$1.1B

Potential to double

Rezdiffra opportunity1

In-licensed new siRNA

targeting PNPLA3

High unmet need, large and growing market and differentiated asset in Rezdiffra

1. Pending successful completion of MAESTRO-NASH OUTCOMES trial and FDA approval; LTM: Last 12 months; F4c: Well-compensated MASH cirrhosis; siRNA: Small interfering RNA.

3

Option D

1Q26

Earnings Call

Agenda

Rezdiffra Launch Update

MASH Pipeline Update

Company Financials

4

Rezdiffra Net Sales: Continuing to Generate Strong Uptake

1Q26 net sales

Rezdiffra Net Sales

$311.3M

$137.3M

YoY % growth

1Q25 1Q26

Generated >$1.1B in net sales in last twelve months

>42,250

>36,250

>29,500

>23,000

>17,000

>11,800

>6,800

>2,000

Steadily Adding Patients in a Large and Growing Market

Patients on Rezdiffra:

Steadily Adding Patients1

Strong Patient Growth YoY

Patient growth since 1Q25

2Q24 3Q24 4Q24 1Q25 2Q25 3Q25 4Q25 1Q26

1. Specialty pharmacy and distribution dispense data.

U.S. F2/F3 MASH Population has Increased Nearly 50 Percent

Since YE 2023; Double Digit Growth Anticipated Going Forward

Key Drivers of MASH Market Growth Since Launch

MASH Market Growth Since YE 20231

Increasing disease

awareness

Increasing diagnosis

Nearly 50% Growth in the F2/F3 Target MASH Market Since YE 2023

U.S. MASH

market expected to grow

double digits

460K

315K

Increasing patients

under specialist care

YE2023 YE2025

1. Diagnosed F2/F3 U.S. MASH patients being seen by target liver specialists; Estes et al. (F2/F3 staging); Forian claims data.

Madrigal is Delivering What the MASH Market Wants:

Rezdiffra is Foundational, Setting a High Bar Now and For the Future

After 2 Years on the Market, We've Learned What Matters Most to Prescribers, Patients and the Community

Best-in-class profile

Real-world

Liver-directed, oral, once daily; consistent efficacy across patient subtypes; well-tolerated; no black box; no titration; no weight gain

Proof points: high persistency, Rx depth; positive

market research on prescriber and patient experience

Broad response across NITs and biomarkers: liver

stiffness, liver fat, liver enzymes, LDL, Lp(a)

performance Proof points: emerging RW data, prescriber testimonials:

"my real-world experience has surpassed my expectations"1

Experienced team; best-in-industry launch; specialty

Leadership: Right

team; right model;

model; first-to-market; an industry-leading MASH pipeline

right start Proof points: 93% HCP satisfaction, improved since semaglutide launch2; >$1.1B LTM sales; >10 pipeline programs

1. "My patients on Rezdiffra are doing even better than I anticipated they would; my real-world experience with the therapy has surpassed my expectations. I have more than 170 patients on Rezdiffra for over a year who have been retested with NITs, and the vast majority of them have not only stabilized but are actually improving." Pierre Gholam, M.D., hepatologist. 2. US Sales Force Effectiveness Research (Fielded Oct - Nov 2025, N=86 HCPs - mix of hepatologists, gastroenterologists, and APPs who support their practice); 93% of target HCPs report high satisfaction with their most recent Madrigal field rep interaction; NIT: Non-invasive test; LDL: Low-density lipoprotein; Lp(a): Lipoprotein-a; RW: Real world; LTM: Last twelve months.

Significant Rezdiffra Prescence Across Multiple Endocrinology, Gastroenterology and Hepatology Medical Meetings

>40

Rezdiffra abstracts across three medical meetings

Madrigal to present most MASH abstracts at EASL including:

Secondary analysis showing Rezdiffra reduced Lp(a) and LDL-C in MASH patients, supporting its potential to reduce CV risk independent of baseline statin use1

Two real-world abstracts demonstrating Rezdiffra's benefit in everyday clinical practice2

1. Bansal, M. Reducing CV risk in patients with MASH independent of baseline based on Lp(a) and LDL lowering by resmetirom [Poster], EASL Congress, May 27 - 30, 2026, Barcelona, Spain; 2. Parinello, C. Twelve-month changes in liver function enzymes and lipids in patients receiving resmetirom [Poster], EASL Congress, May 27 - 30, 2026, Barcelona, Spain; Alkouri, N. Early real-world effectiveness of resmetirom in adults with metabolic dysfunction associated steatohepatitis and moderate-to-advanced fibrosis [Poster], EASL Congress, May 27 - 30, 2026, Barcelona, Spain; AACE: American Association of Clinical Endocrinology; DDW: Digestive Disease Week; EASL: European Association for the Study of the Liver; Lp(a): Lipoprotein-a; LDL: Low-density lipoprotein; CV: Cardiovascular.

Significant Unmet Need in Compensated MASH Cirrhosis (F4c)

Estimated addressable

U.S. patient population

~245,000

Higher urgency to treat given 42x higher risk of liver-related mortality

Rezdiffra tracking to

be first to market

No treatments available today

F4c outcomes trial data expected in

2027

2-year OLE data provides confidence in MAESTRO-NASH OUTCOMES1

1. 2-year OLE data are from the F4c cohort of the Phase 3 MAESTRO-NAFLD-1 trial; OLE: Open-label extension.

New Opportunity in a New Indication with High Unmet Need

Madrigal is Uniquely Positioned to Extend its Leadership in MASH

Our R&D strategy is to build the industry-leading MASH pipeline through targeted business development and internal innovation, leveraging Rezdiffra as the foundational therapy

Deliver transformational outcomes data, securing full approval from F2-F4c

Advance combination therapies anchored by Rezdiffra

Invest in new modalities, including those that enable patient-specific care

Execute disciplined, capital-efficient clinical development (quick go/no-go)

Reducing CSPH Risk Lowers Liver Related Events; Rezdiffra 2-Year F4c OLE Data Support its Potential in F4c

Clinical Significance of CSPH as an Indicator of Outcomes in F4c

w

CSPH 100%

CSPH 41%

CSPH 35%

Probable CSPH 23%

Probable CSPH 24%

No/Low CSPH 42%

No/Low CSPH 34%

2-year OLE F4c data demonstrate

of Rezdiffra patients with CSPH at baseline shifted into a lower-risk category

Baseline Year 1 Year 21

Rezdiffra shifted patients from CSPH to lower risk categories, supporting the

potential clinical benefit of Rezdiffra in F4c

1.Alkouri, N et al. Treatment with resmetirom for up to two years led to improvement in liver stiffness, fibrosis biomarkers, fibrosis scores and portal hypertension in 122 patients with compensated MASH cirrhosis [Presentation], EASL Congress, May 7 - 12, 2025, Amsterdam, the Netherlands; CSPH: Clinically significant portal hypertension; OLE: Open-label extension.

Phase 1 Results Demonstrate up to 46% Reduction in MRI-PDFF1

Adding a New siRNA Program to Our Pipeline with Clinical Stage Candidate, ARO-PNPLA3

Rationale

Liver-directed:

GalNac-conjugated siRNA that has completed Phase 1

Targeted genetic approach: targets homozygous PNPLA3 I148M carriers; ~30% of F2/F3 MASH patients

Rationale:

Combine with resmetirom to develop a tailored genetic approach to treat a specific

40

Percent Change from Baseline

30

20

10

0

-10

-20

-30

-40

-50

-60

Dose administration

Change in Liver Fat Content among PNPLA3 I148M

Homozygous Participants

Placebo (N=10)

high-risk MASH population

0 6 12 18 24

Weeks since Dose Administration

1. Fabbrini E, et al. Phase 1 Trials of PNPLA3 siRNA in I148M Homozygous Patients with MAFLD. N Engl J Med. 2024;391(5):475-476; siRNA: Small interfering RNA; GalNac: N-Acetylgalactosamine; PNPLA3: Patatin-like phospholipase domain-containing protein 3; MRI-PDFF: Magnetic resonance imaging-proton density fat fraction.

MOA

Indication

Preclinical

Phase 1

Phase 2

Phase 3

Launched

THR-β agonist

MASH F2/F3

THR-β agonist

MASH F4c

Ervogastat/resmetirom combo1

Oral DGAT-2 inhibitor

MASH

MGL-2086/resmetirom combo2

Oral GLP-1 receptor agonist

MASH

ARO-PNPLA3/resmetirom combo3

siRNA

MASH

Undisclosed/resmetirom combo

siRNA (6)

MASH

Additional MASH Assets

in varying stages of development

Exploratory oral assets (3)

MASH

1. Ervogastat monotherapy Phase 2b trial completed by Pfizer; drug-drug (resmetirom/ervogastat) interaction (DDI) trial expected to initiate in 4Q26; Phase 2 combination trial expected to initiate in 2027 following regulatory discussions; 2. MGL-2086 Phase 1 single ascending dose (SAD) trial expected to initiate in 2Q26; 3. ARO-PNPLA3 monotherapy Phase 1 trial completed by Arrowhead; MOA: Mechanism of action; THR-β: Thyroid hormone receptor beta; DGAT-2: Diacylglycerol O-acyltransferase 2; GLP-1: Glucagon-like peptide-1; siRNA: Small interfering RNA.

Advancing an Industry-Leading MASH Pipeline to Transform Patient Care

Three Months Ended March 31 (in thousands)1

2026

2025

Revenues:

Product revenue, net

$311,337

$137,250

Operating expenses:

Cost of sales

$26,847

$4,513

Research and development

$108,692

$44,172

Selling, general and administrative

$268,521

$167,876

Total operating expenses2

$404,060

$216,561

Loss from operations

($92,723)

($79,311)

Interest income

$8,243

$9,370

Interest expense

($7,819)

($3,297)

Other expense, net

($2,092)

-

Net loss

($94,391)

($73,238)

Basic and diluted net loss per common, Series A and Series B preferred share

($3.25)

($2.61)

Basic and diluted weighted average number of shares outstanding3

29,032,422

28,085,234

Preparing for Profitability

Strong balance sheet:

$817.9M

In cash, cash equivalents, restricted cash, and marketable securities as of March 31, 2026

1.In thousands except for basic and diluted loss per common share and average number of common shares outstanding; 2. Amounts include stock-based compensation expense as follows for 1Q26 and 1Q25: Cost of Sales: $0.1 million and $0.0, respectively; Research and development: $7.9 million and $5.2 million, respectively; Selling, general and administrative: $26.1 million and $15.7 million, respectively; 3. Basic and diluted weighted average shares outstanding include common stock (22,959,235), as well as previously issued prefunded warrants (3,605,790), previously issued Series A and Series B convertible preferred shares outstanding (2,369,797) and earned PSUs (97,600).

Consolidated Statement of Operations: 1Q26

Rezdiffra

1Q26 net sales:

$311.3M

Madrigal is Well-Positioned for Continued Value Creation in 2026 and Beyond

Rezdiffra F2/F3 Launch

Last twelve months of net sales

Patient

Growth

Patient growth

since 1Q25

F2/F3 MASH

Market Growth

Since YE 2023

Building Our Pipeline

Pipeline programs

Leading the Fight Against MASH

1Q26

Financial Results

May 6, 2026

Aroosha, patient ambassador

Disclaimer

Madrigal Pharmaceuticals Inc. published this content on May 06, 2026, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on May 06, 2026 at 12:11 UTC.