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Madrigal Q4 Earnings Miss, MASH Drug Sales Drive Top Line, Stock Down
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Key Takeaways
MDGL posted a Q4 loss of $2.57 per share as operating expenses surged sharply.
Rezdiffra sales drove $321.1M in Q4 revenues, beating estimates on strong demand.
Madrigal ended 2025 with $958.4M in sales as phase III studies advance toward full approval.
Madrigal Pharmaceuticals (MDGL - Free Report) reported a fourth-quarter 2025 loss of $2.57 per share, in contrast to the Zacks Consensus Estimate of earnings of 4 cents. The large difference is mainly due to a significant rise in operating expenses. In the same quarter last year, the company had incurred a loss of $2.71 per share.
During the quarter, the company generated total revenues of $321.1 million, up significantly year over year, entirely from product sales of its metabolic dysfunction-associated steatohepatitis (MASH) drug Rezdiffra (resmetirom), which was approved in 2024. The metric beat the Zacks Consensus Estimate of $313 million. Rezdiffra is the first marketed drug in MDGL’s portfolio, which was launched in April 2024 and posted significant year-over-year growth, driven by increased demand.
Madrigal shares lost 11.1% on Thursday, likely because the mixed earnings results failed to impress investors.
MDGL’s Q4 Results in Detail
In March 2024, the FDA granted accelerated approval to Rezdiffra, making it the first and currently the only approved therapy for the MASH indication. The eligible patient population includes adults with noncirrhotic MASH with moderate to advanced liver fibrosis. Rezdiffra has also received conditional approval as the first and only therapy in the EU to treat adults with noncirrhotic MASH with moderate-to-advanced liver fibrosis. The drug’s commercial launch is off to a strong start, driven by early patient demand. Per Madrigal, more than 36,250patients are receiving the treatment as of year-end 2025, up from more than 29,500 at the end of the third quarter.
During the quarter, research and development expenses more than quadrupled to $116.3 million in the fourth quarter of 2025. The massive increase can be primarily attributed to upfront payments for business development transactions, partially offset by a reduction in expenses related to clinical studies.
In the past six months, Madrigal shares have gained 7.3% against the industry’s 2.7% decline.
Image Source: Zacks Investment Research
Selling, general and administrative expenses also nearly doubled in the reported quarter to $240 million. This exponential rise was on account of increased commercial launch activities for Rezdiffra, including significant increases in headcount to support commercialization efforts.
Madrigal Pharmaceuticals had cash, cash equivalents and marketable securities worth $988.6 million as of Dec. 31, 2025, compared with $1.1 billion as of Sept. 30, 2025.
MDGL’s Full-Year 2025 Results
In 2025, Madrigal Pharmaceuticals recorded total revenues of $958.4 million, entirely from the sales of Rezdiffra since launch, which beat the Zacks Consensus Estimate of $950.8 million. The company recorded $180.1 million in revenues in 2024.
The company’s loss per share in 2025 was $12.85, wider than the Zacks Consensus Estimate of a loss of $10.30. In 2024, MDGL recorded a loss per share of $21.90.
MDGL’s Pipeline & Other Updates
As the FDA and EU approved Rezdiffra under the accelerated pathway, the continued approval will be based on promising long-term safety and efficacy data from the pivotal phase III MAESTRO-NASH biopsy study. This late-stage study, which provided the data for the drug's accelerated approval for MASH, is ongoing as an outcomes study, with data expected in 2028. The goal is to generate confirmatory 54-month data to verify the drug's clinical benefits and support full approval for the noncirrhotic MASH indication.
In addition to the study, a second phase III outcomes study (MAESTRO-NASH OUTCOMES) is underway, evaluating the progression to liver decompensation events in patients with compensated MASH cirrhosis treated with Rezdiffra compared with placebo. Top-line data is expected in 2027. A positive outcome from this study is also expected to support the full approval of Rezdiffra for noncirrhotic MASH and expand the eligible patient population for Rezdiffra with an additional indication.
The open-label extension (OLE) arm of the MAESTRO-NAFLD-1 study is also currently evaluating the drug in patients with compensated MASH cirrhosis. In 2025, Madrigal reported positive two-year data from the OLE arm. The results reinforce Rezdiffra’s potential benefit for patients with compensated MASH cirrhosis and support the ongoing MAESTRO-NASH OUTCOMES study's potential success. These ongoing studies demonstrate MDGL’s commitment to establishing the drug as the standard-of-care treatment for MASH.
Madrigal Pharmaceuticals, Inc. Price, Consensus and EPS Surprise
Over the past 60 days, estimates for Harmony Biosciences’ 2026 earnings per share have risen from $3.72 to $4.00. HRMY shares have lost 7.8% over the past six months.
Harmony Biosciences’ earnings beat estimates in two of the trailing four quarters, missing the mark on the other two occasions, with the average surprise being 7.20%.
Over the past 60 days, estimates for Immunocore’s 2026 loss per share have narrowed from 97 cents to 90 cents. IMCR shares have risen 1.5% over the past six months.
Immunocore’s earnings beat estimates in three of the trailing four quarters and missed in the remaining one, with the average earnings surprise being 53.96%.
Over the past 60 days, estimates for Castle Biosciences’ 2026 loss per share have narrowed from $1.06 to 96 cents. CSTL shares have surged 55.5% over the past six months.
Castle Biosciences’ earnings beat estimates in three of the trailing four quarters and missed in the remaining one, with the average surprise being 66.11%.
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Madrigal Q4 Earnings Miss, MASH Drug Sales Drive Top Line, Stock Down
Key Takeaways
Madrigal Pharmaceuticals (MDGL - Free Report) reported a fourth-quarter 2025 loss of $2.57 per share, in contrast to the Zacks Consensus Estimate of earnings of 4 cents. The large difference is mainly due to a significant rise in operating expenses. In the same quarter last year, the company had incurred a loss of $2.71 per share.
During the quarter, the company generated total revenues of $321.1 million, up significantly year over year, entirely from product sales of its metabolic dysfunction-associated steatohepatitis (MASH) drug Rezdiffra (resmetirom), which was approved in 2024. The metric beat the Zacks Consensus Estimate of $313 million. Rezdiffra is the first marketed drug in MDGL’s portfolio, which was launched in April 2024 and posted significant year-over-year growth, driven by increased demand.
Madrigal shares lost 11.1% on Thursday, likely because the mixed earnings results failed to impress investors.
MDGL’s Q4 Results in Detail
In March 2024, the FDA granted accelerated approval to Rezdiffra, making it the first and currently the only approved therapy for the MASH indication. The eligible patient population includes adults with noncirrhotic MASH with moderate to advanced liver fibrosis. Rezdiffra has also received conditional approval as the first and only therapy in the EU to treat adults with noncirrhotic MASH with moderate-to-advanced liver fibrosis. The drug’s commercial launch is off to a strong start, driven by early patient demand. Per Madrigal, more than 36,250patients are receiving the treatment as of year-end 2025, up from more than 29,500 at the end of the third quarter.
During the quarter, research and development expenses more than quadrupled to $116.3 million in the fourth quarter of 2025. The massive increase can be primarily attributed to upfront payments for business development transactions, partially offset by a reduction in expenses related to clinical studies.
In the past six months, Madrigal shares have gained 7.3% against the industry’s 2.7% decline.
Image Source: Zacks Investment Research
Selling, general and administrative expenses also nearly doubled in the reported quarter to $240 million. This exponential rise was on account of increased commercial launch activities for Rezdiffra, including significant increases in headcount to support commercialization efforts.
Madrigal Pharmaceuticals had cash, cash equivalents and marketable securities worth $988.6 million as of Dec. 31, 2025, compared with $1.1 billion as of Sept. 30, 2025.
MDGL’s Full-Year 2025 Results
In 2025, Madrigal Pharmaceuticals recorded total revenues of $958.4 million, entirely from the sales of Rezdiffra since launch, which beat the Zacks Consensus Estimate of $950.8 million. The company recorded $180.1 million in revenues in 2024.
The company’s loss per share in 2025 was $12.85, wider than the Zacks Consensus Estimate of a loss of $10.30. In 2024, MDGL recorded a loss per share of $21.90.
MDGL’s Pipeline & Other Updates
As the FDA and EU approved Rezdiffra under the accelerated pathway, the continued approval will be based on promising long-term safety and efficacy data from the pivotal phase III MAESTRO-NASH biopsy study. This late-stage study, which provided the data for the drug's accelerated approval for MASH, is ongoing as an outcomes study, with data expected in 2028. The goal is to generate confirmatory 54-month data to verify the drug's clinical benefits and support full approval for the noncirrhotic MASH indication.
In addition to the study, a second phase III outcomes study (MAESTRO-NASH OUTCOMES) is underway, evaluating the progression to liver decompensation events in patients with compensated MASH cirrhosis treated with Rezdiffra compared with placebo. Top-line data is expected in 2027. A positive outcome from this study is also expected to support the full approval of Rezdiffra for noncirrhotic MASH and expand the eligible patient population for Rezdiffra with an additional indication.
The open-label extension (OLE) arm of the MAESTRO-NAFLD-1 study is also currently evaluating the drug in patients with compensated MASH cirrhosis. In 2025, Madrigal reported positive two-year data from the OLE arm. The results reinforce Rezdiffra’s potential benefit for patients with compensated MASH cirrhosis and support the ongoing MAESTRO-NASH OUTCOMES study's potential success. These ongoing studies demonstrate MDGL’s commitment to establishing the drug as the standard-of-care treatment for MASH.
Madrigal Pharmaceuticals, Inc. Price, Consensus and EPS Surprise
Madrigal Pharmaceuticals, Inc. price-consensus-eps-surprise-chart | Madrigal Pharmaceuticals, Inc. Quote
MDGL’s Zacks Rank & Stocks to Consider
Madrigal Pharmaceuticals currently carries a Zacks Rank #4 (Sell).
Some better-ranked stocks in the biotech sector are Harmony Biosciences (HRMY - Free Report) , Immunocore (IMCR - Free Report) and Castle Biosciences (CSTL - Free Report) , each sporting a Zacks Rank #1 (Strong Buy) at present. You can see the complete list of today’s Zacks #1 Rank stocks here.
Over the past 60 days, estimates for Harmony Biosciences’ 2026 earnings per share have risen from $3.72 to $4.00. HRMY shares have lost 7.8% over the past six months.
Harmony Biosciences’ earnings beat estimates in two of the trailing four quarters, missing the mark on the other two occasions, with the average surprise being 7.20%.
Over the past 60 days, estimates for Immunocore’s 2026 loss per share have narrowed from 97 cents to 90 cents. IMCR shares have risen 1.5% over the past six months.
Immunocore’s earnings beat estimates in three of the trailing four quarters and missed in the remaining one, with the average earnings surprise being 53.96%.
Over the past 60 days, estimates for Castle Biosciences’ 2026 loss per share have narrowed from $1.06 to 96 cents. CSTL shares have surged 55.5% over the past six months.
Castle Biosciences’ earnings beat estimates in three of the trailing four quarters and missed in the remaining one, with the average surprise being 66.11%.