Madrigal Pharmaceuticals, Inc. Q1 FY2026 earnings call

• Bill discussed ResDifera's performance, achieving blockbuster status with over $1.1B net sales in 12 months, low penetration, expanding market. Advancing F4C outcomes trial for indication expansion. Added new siRNA asset targeting PNPLA3 gene. - Dave talked about R&D strategy: deliver outcomes data and full approval for ResDifera from F2 to F4C, advance complementary combination therapies, remain modality agnostic, design smarter trials. Highlighted ARO PMPLA-3 siRNA asset, its target relevance, and potential. - Marty reviewed financials: Q1 2026 net sales strong, expect gross to net discount mid to high 30s for rest of 2026, R&D and SG&A expenses discussed, balance sheet with $817.9M cash, cash equivalents, etc. at end of Q1 2026.

First quarter 2026 net sales were $311 million, representing year-over-year growth of 127%. ResDifera has achieved blockbuster status, generating more than $1.1 billion in net sales in the last 12 months. The U.S. addressable market for MASH has grown nearly 50% from 315,000 patients at the end of 2023 to 460,000 patients at the end of 2025. ResDifera has over 42,250 active patients, and year-over-year patients on therapy increased by two and a half times compared to Q1 2025. Cost of sales for Q1 2026 was $26.8 million compared to $4.5 million in the prior year period, primarily reflecting royalties owed to Roche. R&D expenses for Q1 2026 were $108.7 million compared to $44.2 million in the prior year period, increase due to one-time upfront business development expenses. SG&A expenses for Q1 2026 were $268.5 million compared to $167.9 million in the prior year period, increase due to investment in commercial activities for ResDifera.

• Expect full year 2026 R&D expenses to be roughly same as 2025. - Full-year 2026 SG&A expenses to increase with annualization of end of Salesforce. - Q2 2026 off to great start. - Maestro NASH outcomes trial expected to read out in 2027 with events tracking in range of expectations.

Q: Congrats on the quarter, what are you seeing on the 2Q trend so far and expectations for patient ads for the rest of the year, and impact of Wagovi on ResDifera?

A: Q2 trends great, off to strong start, steadily adding patients, Wagovi not to detriment of ResDifera, best MBRX month since launch.

Q: Can you talk about the breadth of prescribing right now and how it could evolve, and new patient ad dynamic?

A: Over 10,000 prescribers, gastroenterologists outnumber hepatologists 10 to 1, endocrinology starting to be a productive specialty, Q1 new patient adds due to Q1 effect, expect to steadily add patients throughout rest of year.

Q: Question about patient mix, evolution of combo use with GLPs, and F2, F3 split?

A: Still see 25+% of patients on ResDifera also on GLP-1, over 50% previously exposed, F2-F3 split about 50-50.

Q: High-level question on diagnostic growth, SG&A, profitability, and full year estimates?

A: Market grew 50% in 2 years, diagnostics growing, SG&A to support brand, profitability inevitable, full year estimates in mid to high 30s for gross to net discount.

Q: Maestro outcome visibility and event tracking?

A: Maestro NASH outcomes trial events tracking in range of expectations, expected to deliver in 2027, will provide update when more precise.

Q: Combination use with GLP-1 and payer coverage?

A: Around 25% of patients on ResDifera also on GLP-1, expect increase, great access to ResDifera, payers allowing GLP-1 for other indications with ResDifera for MASH.

Q: Pipeline clinical strategy, positioning of combos, and BD appetite?

A: Pipeline has over 10 programs, looking for mechanisms to combine with ResDifera, BD appetite for potential MASH opportunities, will be capital-efficient, data-driven in advancing programs.

Q: Master outcome baseline platelet count difference and event rate?

A: F4C population not monolithic, outcomes trial enriches population using various criteria, populations broadly comparable, rates of CSPH in line with expectations.

Q: PNP LA3 asset attractiveness and diligence?

A: Madrigal sees PNP LA3 as validated target, complementary to ResDifera, clinical stage asset with phase one data, showing reduction in liver fat, siRNA modality, validated target for MASH.

Q: Rank order of NASH combos and clinical thinking?

A: Each asset brought in for potential to move needle on efficacy, decision to move forward into phase three programs based on combination data, proof will come from phase two, data-driven approach.

Q: Path to peak sales for ResDifera?

A: Continue current efforts, diagnosis rates increasing, more patients on drugs, market growing, penetration rate low, will find path to peak sales through steady patient addition.