Madrigal Pharmaceuticals, Inc.

First quarter 2026 net sales were $311.3 million, up 127% year over year. Cost of sales was $26.8 million versus $4.5 million in the prior-year period, R&D expense was $108.7 million versus $44.2 million, SG&A was $268.5 million versus $167.9 million, and net loss was $94.4 million versus $73.2 million. The quarter included $34 million of noncash stock-based compensation and $54.3 million of one-time upfront business development expense. Madrigal ended Q1 with $817.9 million in cash, cash equivalents, restricted cash and marketable securities, down from $988.6 million at the end of 2025. For 2026, management expects gross-to-net in the mid- to high-30s for the rest of the year, full-year R&D roughly in line with 2025, and full-year SG&A higher than 2025, with Q2 SG&A elevated due to timing of marketing spending. They also said they are good with the current full-year consensus cited on the call and reiterated that they do not expect to be profitable in 2026; Q2 will also not be profitable because of the PNPLA3 acquisition.

Bill Sibold framed the quarter as evidence that Rezdiffra is becoming the foundational therapy in an early-stage but rapidly expanding MASH market. He emphasized more than $1.1 billion in trailing 12-month net sales, over 42,250 active patients, strong Q2 momentum, and no material negative impact from competing GLP-1s, which he characterized as increasingly a background therapy. His tone was highly confident and expansionary, focusing on peak-sales potential, F4C as a major next growth phase, and building what he called an industry-leading pipeline around Rezdiffra.

Mardi Dier focused on the quarter’s financial mechanics and gave specific context for profitability and cash use. She said Q1 revenue benefited from strong patient adds but had the typical Q1 gross-to-net effect from benefit plan changes and a step-up related to first-line commercial contracting; even so, gross-to-net came in better than expected and is now expected to stay in the mid- to high-30s for the rest of 2026. She cited $26.8 million of cost of sales, $108.7 million of R&D, $268.5 million of SG&A, and $817.9 million of quarter-end cash and marketable securities, noting the company is preparing for profitability but does not expect to be profitable in 2026.

Analysts focused on Q2 trends, patient adds, the effect of GLP-1s, prescriber breadth, diagnosis growth, gross-to-net, and the MAESTRO outcomes trial. Management said Q2 is off to a strong start, patient growth should continue steadily, and they do not see Rezdiffra being harmed by GLP-1 usage; roughly 25% of patients are on a GLP-1 concomitantly and payer access remains strong. On the pipeline, management said F4C events are tracking within expectations and still point to a 2027 readout, while the newly in-licensed PNPLA3 asset was attractive because it targets a validated genetic driver and showed up to a 46% liver-fat reduction in Phase I.