Madrigal Pharmaceuticals is continuing to splash the cash this year on liver disease drugs it can combine with its own potential blockbuster Rezdiffra.
Just weeks after betting $50 million on a DGAT2i inhibitor from Pfizer, Madrigal has turned to China’s Ribo Life Science and its Swedish subsidiary Ribocure Pharmaceuticals to source six preclinical siRNA programs in a heavily back-loaded deal. The idea is for Madrigal to develop next-generation siRNA therapies that silence genes implicated in metabolic dysfunction-associated steatohepatitis (MASH).
As siRNAs are highly liver targeted, there are “several genes implicated in MASH that could be addressed with an mRNA-knockdown approach,” Madrigal Chief Medical Officer David Soergel, M.D., explained in a Feb. 11 release.
Madrigal is paying $60 million upfront with potentially up to $4.4 billion in biobucks to follow, as well as royalties on sales.
Madrigal’s thyroid hormone receptor-beta (THR-beta) agonist Rezdiffra became the first-ever drug to be approved by the FDA for MASH back in 2024. The therapy has proven a hit for the company, which is expecting full-year sales for 2025 to top $1 billion.
“The precision of siRNA gene silencing, combined with Rezdiffra, has the potential to create the next generation of MASH treatment: genetically targeted therapies for patients with unmet needs,” Soergel added in this morning’s release.
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Madrigal acquired Pfizer’s DGAT2i inhibitor, called ervogastat, last month with a similar plan to expand Rezdiffra’s potential.
The Pfizer and Ribo deals are just two examples of flurry of dealmaking in the past year that also saw Madrigal pay China’s CSPC Pharmaceutical $120 million in July 2025 for a preclinical GLP-1 receptor agonist. Again, the idea is to pair the asset with Rezdiffra.
“At the start of 2025, Madrigal was a single-product company launching the first medication for MASH,” CEO Bill Sibold pointed out in today’s release.
“Today, we have the foundational therapy in Rezdiffra, a fully enrolled F4c outcomes study, and an industry-leading MASH pipeline with more than 10 programs targeting different drivers of the disease,” Sibold added.
Madrigal may have been the first to score an approval for the tricky indication of MASH, but there is plenty of competition on the horizon—including from Novo Nordisk’s GLP-1 Wegovy, which gained an FDA label expansion for the disease last year.
