Madrigal Q3 revenue tops estimates as Rezdiffra sales rise 50%

Madrigal (MDGL) said third-quarter 2026 net revenues rose 50% from a year earlier to $431.3 million, topping the $412.35 million revenue estimate.

Shares were little changed in premarket trading as of 9:19 a.m. ET.

The company also swung to a profit. Net income was $55.4 million, or $1.83 per diluted share, compared with a net loss of $114.2 million, or $4.01 per share, a year earlier. The estimate for the quarter was a loss of 93 cents per share.

Here's how the company did:

• Net revenues: $431.3 million vs. $287.3 million a year earlier
• Diluted net income per share: $1.83 vs. a loss of $4.01 a year earlier
• Operating expenses: $375.3 million vs. $401.2 million a year earlier

Madrigal's medication, Rezdiffra (resmetirom), is a once-daily, oral, liver-directed treatment for metabolic dysfunction-associated steatohepatitis, or MASH, a serious liver disease. Sales of the drug drove the quarter.

“Madrigal delivered another strong quarter, driven by continued Rezdiffra demand, deepening prescriber adoption and accelerating market growth. 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,” Chief Executive Officer Bill Sibold said.

More than 55,850 patients were on Rezdiffra as of Sept. 30, 2026, nearly doubling from the third quarter of 2025, the company said.

Trial and conference updates

Madrigal plans to start MAESTRO-CSPH, a second Phase 3 outcomes trial in compensated MASH cirrhosis, known as F4c. The trial is expected to enroll more than 2,000 patients, and initiation is expected in the first half of 2027, subject to regulatory discussions.

The company said 18 of its abstracts were accepted for the American Association for the Study of Liver Diseases (AASLD) Liver Meeting, which runs Nov. 5-9 in Denver.

The board appointed John C. Reed, M.D., Ph.D., in August. Reed is executive vice president, innovative medicine, research and development at Johnson & Johnson.

Costs and cash

Cost of sales rose to $37.8 million from $18.1 million, primarily because of higher royalties payable to Roche on increased Rezdiffra sales. Research and development expenses fell to $71.8 million from $174.0 million, mainly because a one-time upfront business development expense of $117.3 million hit the year-earlier quarter.

Selling, general and administrative expenses rose to $265.7 million from $209.1 million, driven by commercial investment for Rezdiffra, including the endocrinology field force expansion and a direct-to-consumer campaign.

Cash, cash equivalents, restricted cash and marketable securities totaled $961.8 million as of Sept. 30, 2026, compared with $988.6 million at Dec. 31, 2025.