Madrigal Pharmaceuticals swings to profit as Rezdiffra tops $1 billion

Madrigal Pharmaceuticals posted GAAP net income of $55.4 million in the third quarter of 2026, or $1.83 per diluted share, swinging from a net loss of $114.2 million a year ago. Analysts had expected a loss of $1.09 per share, so the quarter beat expectations and marks a structural crossing into profitability.

The engine behind the turn is Rezdiffra, Madrigal's MASH therapy, which generated $431.3 million in net sales for the quarter, up 50% year over year and beating the $405.1 million consensus. Year-to-date net sales reached $1.1 billion, giving Rezdiffra blockbuster status in fewer than three years on the market. More than 55,850 patients were on therapy as of September 30, nearly double the year-ago level.

Part of the profit swing came from a sharp decline in R&D expense to $71.8 million from $174 million a year earlier, when the prior period carried a $117.3 million one-time business development charge. SG&A rose to $265.7 million from $209.1 million as the company expanded its endocrinology field force and ran a direct-to-consumer marketing campaign, signaling continued commercial investment as the primary lever.

The addressable U.S. F2-F3 MASH market already exceeded 530,000 patients through June 30, 2026, and Madrigal expects that figure to grow more than 30% by year-end. The company plans to initiate the Phase 3 MAESTRO-CSPH cirrhosis outcomes trial, targeting more than 2,000 patients, in the first half of 2027, opening a second market in well-compensated MASH cirrhosis. Data from the ongoing MAESTRO-NASH OUTCOMES trial are expected in late 2027.

CEO Bill Sibold framed the milestone directly: "Rezdiffra surpassed $1 billion in year-to-date net sales, achieving blockbuster status less than three years after launch, and we are still early in a rapidly growing market." No financial guidance was issued alongside the results.